Your string of shifts is almost over when you are called into a room for an infant with respiratory distress. You?ve just seen 4 kids with upper respiratory infections, and you feel confident that this is the scenario. The 4-month-old, who was born at 26 weeks? gestation, shows mild-to-moderate respiratory distress; however, there has been no viral prodrome. A chest x-ray demonstrates moderate pulmonary edema. Back in the room, you note that her blood pressure is 110/80 mm Hg, and you begin to wonder whether that is high for an infant. What additional testing?if any?is necessary? Do you need to intervene? Is there anything specific you should be worried about?
The 4-month-old girl had clear evidence of cardiac failure and hypertension. She was started on an esmolol drip that was slowly titrated, and given a dose of furosemide. Her work of breathing slowly improved, and she was admitted to the intensive care unit, where it was learned that she had had an umbilical arterial line and had a renal artery thrombosis.
Would you have done it different? Tell us how you would have handled this case.