Haemodynamic instability in the preoperative neonate with cyanotic congenital heart disease impacts morbidity and mortality. The use of cerebral and somatic oximetry may provide an early warning of impending shock, prior to acidosis.

A 2.78 kg infant presented with transposition of the great vessels. Cerebral and somatic oximetry was initiated. The infant became febrile, with tachycardia and poor urine output (B). Tachypnoea and tachycardia (D) worsened, followed by apnoea and unresponsiveness (E). The patient was intubated and assisted ventilation begun. Arterial blood gas revealed pH 7.11, PaCO₂ 16, PaO₂ 70, base deficit −24. The infant developed cardiac arrest requiring resuscitation. The patient was emergently placed on extracorporeal life support (F), subsequently developing asystole. Life support was discontinued and the infant died. Autopsy did not elucidate a cause of death.

A rapid response to declining cerebral and renal rSO₂ values may have prevented this untimely death. Rapid decline preceded the development of acidosis, a commonly used marker of distress in the preoperative neonate with congenital heart disease. We suggest routine preoperative monitoring in the infant with cyanotic congenital heart disease, using two-site cerebral and renal oximetry.

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Anschutz et al