Isaac Martin, MBBS, MD, MRCPCH
The Hospital for Sick Children, Toronto, ON

This case is of a term baby born after a normal pregnancy by spontaneous vaginal delivery in good condition but who developed persistent desaturation with a pre-post ductal difference in the first day of life. At her local hospital, heated high flow nasal cannula oxygen was initiated and a prostaglandin (PGE1) infusion commenced when echocardiogram demonstrated an atrioventricular septal defect (AVSD) and interrupted aortic arch (IAA). She was transferred to SickKids in Toronto for surgical management but had increasing pulmonary hypertension necessitating escalation. In this presentation, we formulate a list of differential diagnoses to be considered in such a case as well evaluating different investigations including imaging modalities, genetic testing and lung biopsy. Ultimately, we will appraise the literature describing the indications and feasibility of infant lung transplant as well as when palliation should be considered.

Learning Objectives
At the end of this presentation, attendees will be able to:

  • Come up with a broad differential for neonatal respiratory distress in term babies;
  • Describe the different investigations and findings consistent different interstitial lung disease processes; and
  • Appraise the indications and contraindications for infant lung transplant.

CanMEDS Roles Addressed: Communicator , Health Advocate, Medical Expert