LAUSR

You are a neonatologist in a small rural hospital with a newborn nursery and no pediatric cardiology services. The nearest hospital with a NICU and pediatric cardiology services is 50 miles away. The closest tertiary care hospital, with all pediatric surgeries and subspecialties, is 100 miles away. An obstetrician wants your advice about the delivery plan for a pregnant woman with the fetal echocardiogram shown (Video). The family is currently planning on a home delivery. You counsel the family about the next steps for delivery. What is the best advice to give this family? 1. Deliver at home as planned because the infant is at low risk for initial medical needs 2. Deliver in the local hospital, transition with the mother in the nursery, and obtain an electrocardiogram before discharge 3. Deliver in the nearest hospital with a NICU and pediatric cardiology services, monitor oxygen saturations, and obtain an echocardiogram before discharge 4. Deliver in the nearest tertiary center, admit to the NICU, place umbilical lines, and start prostaglandin infusion 5. Deliver in the nearest tertiary center and plan for emergency cardiac surgery after birth Video. Click here to view the video. Fetal echocardiogram of a fetuswith tetralogy of Fallot. This video demonstrates a large ventricular septal defect, an overriding aorta, and mild obstruction of the right ventricular outflow tract. The 4th component of “tetralogy” is right ventricular hypertrophy, which is not well demonstrated in this clip. Which laboratory test, if performed, is most likely to have an abnormal …