Kettering Neonatal/Pediatric Specialist (NPS) Practice Exam

In this scenario where a 6-day-old neonate presents with profound cyanosis and an egg-shaped heart shadow on X-ray, it is essential to consider the likely diagnosis. The egg-shaped heart shadow is characteristic of toF (Tetralogy of Fallot) or transposition of the great arteries (TGA). In particular, TGA often requires urgent intervention due to significant cyanosis caused by inadequate mixing of oxygenated and deoxygenated blood.

Balloon atrial septostomy is a procedure that is indicated in cases of TGA. It allows for improved mixing of blood by creating a temporary hole between the atria, thereby alleviating the severe cyanosis. This intervention is crucial in neonates with TGA as it stabilizes the patient's condition and allows for better oxygenation before definitive surgical correction can be performed.

In contrast, options such as indomethacin, which is often used for closing patent ductus arteriosus (PDA) in preterm infants; diuretics, typically used for managing fluid overload or heart failure; and pulmonary artery banding, which is mainly a palliative procedure for certain types of congenital heart defects, are not appropriate in the immediate management of a neonate with profound cyanosis and an