3month old baby with cough difficulty in breathing refusal to feed stuprose spo2 70% tachponea tachcardia flaring of nostril .full of crepts.tc 17 t n78% dehydrated .xray shows bl upper lobe haziness . put baby on ceftrizone and clindamycin and supporyive measure.not much improved in nest two days repeat xray and ecocardigraphy with bila consolidation and ryt ventricular dilatation with severe pulmonary hpertention.repot attached.please line of treatment.

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Add vancomycin

Ddx Pneumothorax,CDH,Bronchopneumonia

Pneumonia has to be tackled. Isolated ASD per se is not the cause of this PAH. There is no pulmonary plethora on CXR. Regards

Asd with pulmonary hypertension

AS D with PH

8ASD with PAH

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Detail birth history .are we missing TAPVC .just give thought .and in case if this PH is primary then u can start sildenafil .regarding pneumonia u can mechanical ventilate baby if hypoxia not improved .even on initial antibiotics changing antibiotics will not help but until we controlled. PH

Agreed sir, this much PAH is also not explained by atrial shunt. As visualised from images venous drainage seems normal to LA.
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You missed gram_ve coverage

Cefuroxime is having maximum grampisive coverage and is the drug of choice in empirical pneumonia
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Rapidly progressing pneumonia associated with congenital heart disease and pulmonary hypertension. Size of the Asd is not mentioned very large ASD with pulmonary hypertension is possible. In this case H1N1 pneumonia is to be considered . Features of staff pneumonia is not seen. Klebsiella can sometimes present like this. If total countl is low before sending for throat swab for PCR for H1N1 fluvir can be started. Cfuroxime and amikacin are better antibiotics to consider

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