You are the primary care provider for a 5-week-old infant. Hismother has brought him to the office today with a complaint of poorfeeding. His mother states that he will breathe very fast duringfeedings and seems to get tired. It is taking him over an hour todrink his bottle. His mother did not have any prenatalcomplications, and he did not have any complications during thedelivery. At birth his Apgar scores were 9 and 10. His weight gainhas been as expected over the past month, but you noted that sincehis 4-week check-up he has not gained any weight. On assessment younote a loud, harsh, holosystolic murmur at the lower-left sternalborder. This murmur was not noted on previous assessments. Duringthe assessment you note that he has circumoral cyanosis whilecrying. His mother is not happy and mentions that she had acongenital heart defect when she was a baby. She asks if this isthe problem now with her own baby and why it was not detectedbefore.
How would you communicate your concerns to the mother? What doyou suspect is the cause for the poor feeding and delayed growth?How would you recommend managing cyanosis? Will you refer thepatient to a specialist? If so, what type of testing and treatmentcan his mother expect?