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low O2 sats in infant---why cardiology referral?

I have a four month old son who got RSV along with the whole household in early February. We live at altitude (7200) feet, but the baby did well--- one night of observation in the hospital, where his O2 sats were 96-97 when he was being held or was upright, but would fall when sleeping or laying down into the mid-80s. So, he went on oxygen.

Two months later he is still failing every overnight oxygen study in order to get him off nighttime oxygen. He still is doing the same thing--- upright O2 sats 97, laying down/sleeping O2 sats in the mid-80s. The pediatrician ordered a chest x-ray which showed lungs look fine, heart looks bigger than it should (which I know from my other kids is a result of exhaling/inhaling perfectly when taking the x-ray). He ordered a pulmonary consult as well, which I can understand. However, I also got a cardiology referral in the mail, which took me totally by surprise.

I was born with a couple of CHDs that are fine now (ASD and SVT), I also have a daughter who is now three who was born with multiple CHDs and has already had open heart surgery and is looking at future surgeries. This pregnancy I had a level II with a focus on the heart and all looked fine. My son was born at 8 1/2 pounds and at four months is 85% weight and height. He's as active as a four month old can be, with no murmurs and no concerning heart sounds and otherwise has been the very picture of health.

I'm trying to figure out what point there would be to a cardiology consult on top of a pulmonary consult? At this point I really don't care to spend extra time at extra appointments that aren't really necessary. I plan on calling his ped. to ask, but I figured I would see if there was any idea on what a ped. cardiologist could possibly be looking for in this circumstance.
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773637 tn?1327446915
Dear Rjthkids,

Respiratory syncytial virus (RSV) is a virus that can cause severe pulmonary infections in infants.  The effects of this, especially in the still developing lungs after birth, can take a long time from which to recover.  However, you have a special circumstance that complicates things:  you live at significant altitude.  The relative lack of oxygen at that altitude can lead to elevated blood pressure across the lungs, which is called pulmonary hypertension.  Studies from The Children’s Hospital in Denver show that infants and children living at altitude are at greater risk to have pulmonary hypertension, with need for more supplemental oxygen, or even other therapies.  This can be variable, though, based on genetics.  Therefore, the pediatric cardiologist will want to assess for evidence of elevated blood pressure on the right side of the heart.  This can be done with a combination of the physical examination, electrocardiogram (ECG), and an echocardiogram (cardiac ultrasound).  The echocardiogram would also look for other structural defects in the heart that may be contributing to your child’s decreased oxygen saturations, especially one called pulmonary atresia with ventricular septal defect, a congenital defect that can be missed early on and still progress to worsening cyanosis.  Therefore, it is not unreasonable that your son be evaluated by not only a pulmonary specialist but also by a cardiologist in this case.
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Avatar universal
To add more specificity--- his last overnight study was 1 week ago and he spent 85% of the time at o2 sats between 90-93, and 14% of the time between 80-89%, but all of that time was actually spent between 80-85 and 1% of the time below 80%. This is consistent with his other 3 studies and his hospital overnight. I have an older child with significant chronic lung disease and asthma so I'm well-versed in using pulse-ox machines for accurate results on wiggly infants.
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