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Unexpected outcome (positive or negative) including adverse drug reactions
Arrival and survival of a 3-week-old boy from Pakistan with an arterial oxygen saturation of 17%
  1. Georg Hansmann1,
  2. Felix Haas2,
  3. Masood Sadiq3,
  4. Michael Brook4,
  5. Hans Peter Gildein5
  1. 1
    Department of Cardiology, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115, USA
  2. 2
    Division of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, UMC Utrecht, 3508 AB, Utrecht, The Netherlands
  3. 3
    Paediatric Cardiology, The Children's Hospital/The Institute of Child Health and Punjab Institute of Cardiology, Lahore, 54000, Pakistan
  4. 4
    Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, California, USA
  5. 5
    Department of Pediatric Cardiology, German Heart Center, Munich, Germany
  1. Georg Hansmann, georg.hansmann{at}


In newborn infants, acute perinatal hypoxic/ischaemic events and associated hyperoxia/reperfusion injury frequently lead to devastating neonatal brain damage. The present report concerns a 3-week-old boy from Pakistan with d-transposition of the great arteries (d-TGA), prolonged and severe hypoxaemia, and multiresistant bacterial sepsis. The term newborn infant underwent public airline transportation to Europe and presented on the airport’s runway with severe hypoxaemia (pulsoximetric oxygen saturations (SpO2) 17%) and systemic hypotension. The patient eventually underwent late balloon atrial septostomy, followed by a successful two-stage arterial switch operation. A clinical follow-up 3–5 years later revealed lack of cerebral dysfunction, adequate neurodevelopment, good biventricular function, regular coronary flow, as well as normal ECG, blood pressure and SpO2. The findings may indicate the neonatal brain adjusts better to chronic, slowly worsening hypoxia than to acute hypoxia (eg, “birth asphyxia”), and also suggests a greater tolerance for chronic hypoxia in neonates vs adults.

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  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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