Which of the following is a sign of heart failure in a neonate with a congenital heart defect?

Feeding difficulties are commonly observed in neonates with heart failure, particularly those with congenital heart defects. In these cases, infants may have an increased work of breathing or exhaustion due to their compromised cardiac function, leading to a decreased ability to feed effectively.

Moreover, heart failure in neonates can cause inadequate nutrient intake because they tire easily during feeding, and they may have an increased rate of respiratory distress, which further impacts their ability to consume milk. Poor feeding may indicate that the neonate is not adequately circulating blood and oxygen to meet metabolic demands.

In the context of heart failure symptoms, mottling occurs due to poor perfusion and can be an early indicator of circulatory compromise. Mottling typically appears as a patchy or irregular pattern of discoloration on the skin and can suggest inadequate blood flow, which relates to the heart's inability to pump effectively. In contrast, hyperglycemia, bounding pulses, and various other signs may not directly suggest heart failure in neonates with congenital defects as clearly as feeding difficulties or mottling.

Thus, recognizing feeding difficulties is critical, as they can serve as an early sign of heart failure in neonates, prompting further evaluation and management.