Reference no: EM133925547

Question

A 2-day-old female infant was transferred for admission to the Children's Hospital after being noted to be hypoxemic soon after birth. She was a full-term infant from an uneventful pregnancy. A transthoracic contrast echocardiogram of the pediatric heart done on admission did not reveal any major cardiac defects. However, there was right-to-left shunting suggestive of primary pulmonary hypertension in a newborn or persistent fetal circulation. The physicians were concerned about her episodes of significant hypoxemia. During the morning of day 2 the infant required significantly increased inotropic medication support to maintain her hemodynamics. Given the lability as well as the increase in inotropes, it was felt that she would benefit from ECMO support. Neurologically, some movements had been noted earlier today, and the liver function and renal function tests were within normal range, suggesting that there was no significant end-organ injury related to the hypoxia. The infant was taken to the operating room and sedated with fentanyl, Versed, and vecuronium. A transverse skin incision was made 2 cm above the medial aspect of the clavicle and extended down through the subcutaneous tissues and platysma. The internal jugular vein and the carotid artery were identified. Two Ethibond ties were passed proximal.