Topics Discussed: cardiology; hemoperfusion; hypoperfusion; perfusion.
Excerpt:"Problem. You receive a report that an infant "doesn't look good" or looks "mottled." Other descriptions may include "a washed-out appearance" or "poor perfusion."
Immediate questions
- What is the age of the infant? Hypoplastic left heart syndrome may cause poor perfusion and a mottled appearance. It may be seen at days 1–21 of life (more commonly at day 2 or 3). In an infant <3 days old, sepsis may be a cause. Associated risk factors for sepsis are premature rupture of membranes, maternal infection, and fever.
- What are the vital signs? If the temperature is lower than normal, cold stress or hypothermia associated with sepsis may be present. Hypotension may cause poor perfusion (see normal blood pressure values in Appendix C). Decreased urine output (<2 mL/kg/h) may indicate depleted intravascular volume or shock.
- Is the liver enlarged? Is there metabolic acidosis, poor peripheral pulse rate, and a gallop present? These problems are signs of failure of the left side of the heart (eg, hypoplastic left heart syndrome). Poor perfusion occurs because of reduced blood flow to the skin.
- If mechanical ventilation is being used, are chest movements adequate and are blood gas levels improving? Inadequate..."
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