Increased Fontanelle Tension as Early Sign of Cardiac Failure

We have recently noted that an increase in tension of the anterior fontanelle has preceded the usual signs and symptoms of cardiac failure in infancy. After reviewing the standard pediatric and cardiology textbooks and pertinent literature, we have found that this physical finding is not listed as a sign of heart failure in infancy. CASE 1: A newborn with dextrocardia (without situs inversus) had shown cyanosis, when oxygen was not administered, and tachypnea since birth.