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NeoReviews Vol.8 No.9 2007 e394
© 2007 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.


   Case Presentation
 
A 2.6-kg infant was born at 38 weeks’ gestation to a 16-year-old G1P0 woman. The prenatal history included maternal Chlamydia infection. The baby was delivered via emergent cesarian section because of nonreassuring fetal heart tones. His Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. He exhibited tachypnea and hypoxia at birth, with a respiratory rate of 80 to 100 breaths/min, grunting, chest retractions, and coarse breath sounds. Other than a mild systolic ejection murmur, the remainder of the physical examination findings were normal. The baby's A-a gradient (a measure of the difference in the partial pressure of oxygen in the alveolar spaces and the arterial blood) was elevated, initially 473 mm Hg on 100% FiO2. Chest radiographs showed no signs of acute air space disease for the first several postnatal weeks.

Over the next several months, the infant continues to have a respiratory rate of 60 to 90 breaths/min, with increased work of breathing, gradually requiring increases in supplemental oxygen to achieve an SpO2 in the mid-90s. Chest computed tomography (CT) scan performed at 2 weeks of age showed attenuation of the pulmonary vasculature and hyperinflation of the lungs. Although motion artifact limited the evaluation, the chest CT showed no focal lung opacities and no other anatomic defects. Repeated echocardiography revealed a small patent foramen ovale (left-to-right shunt) and normal ventricular size and function. Multiple therapies are tried without . . . [Full Text of this Article]

Katharine Kevill, MD
Richard Auten, MD

Department of Pediatrics, Duke University, Durham, NC






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