Counsel parents of a newborn with a suspected duct-dependent cardiac lesion — OSCE

Candidate brief

You have eight minutes to counsel the parents of a thirty-hour-old term infant found on routine pulse-oximetry screening to have a saturation of 86 per cent in air while looking well. The plan is to start a prostaglandin infusion and transfer to a cardiac centre before the echocardiogram. Use a structured, honest and empathic approach that explains the finding in plain language and builds a shared plan. [2] [1]

Key teaching and communication objectives

Acknowledge and validate the parents' fear and bewilderment before delivering information, and allow silence. Explain in plain language that the low oxygen reading means their baby's blood is not being oxygenated as it should, that this can be caused by the way the heart's plumbing formed, and that the baby looks well now because a small vessel called the ductus is still open and doing the work — but that vessel naturally closes in the first days of life, which is why this is being treated as urgent even though the baby looks comfortable. [2]

Address the drug and the transfer directly. Explain that the prostaglandin infusion keeps that small vessel open and gives the team time to image the heart and plan the repair, that it is started before the scan because waiting risks the vessel closing, and that the transfer to the cardiac centre is arranged with specialists who will take over the care. Name the side-effect that matters most — that the drug can slow the baby's breathing, which is why the airway will be watched and, if needed, supported for the journey. [9] [8]

Frame the prognosis honestly. Explain that most of these lesions can be repaired and that the reason for the urgency is to reach that repair safely rather than in a collapse, and that the screening programme exists precisely to catch this early. Avoid false certainty about the exact diagnosis before the scan, but offer the honest reassurance that early detection is exactly what gives the best chance of a good outcome, and that the team will update them as soon as the heart is imaged. [1]

Close with a shared plan and a clear next step: the infusion and the transfer, the name of the receiving team and the coordinator, a connection to cardiac family support, and an open invitation to ask questions and to be with their baby wherever possible. Confirm understanding, check the family's practical needs for the journey, and document the conversation. [2] [8]