In a 3-day-old infant with heart issues, which defect is suspected if the nurse notes +3 brachial pulses but cannot palpate a femoral pulse?

In a 3-day-old infant, the presence of +3 brachial pulses alongside the inability to palpate femoral pulses is indicative of coarctation of the aorta. This congenital defect involves a narrowing of the aorta, typically occurring just after the arteries that supply blood to the arms and head.

When coarctation is present, the blood flow is preferentially directed to the upper body, leading to stronger pulses in the upper extremities, such as the brachial pulse, while the blood flow to the lower body, including the femoral arteries, is reduced. This results in weakened or absent femoral pulses compared to the more robust pulses observed in the arms.

The clinical significance of these findings is crucial for identifying coarctation early, as it can lead to serious complications if not treated promptly. Recognizing the differences in pulse quality between the upper and lower body helps healthcare providers assess the adequacy of circulation and make appropriate interventions.