Concluded Case

A NOISY NEONATE

A neonate presented with respiratory distress just after birth.Baby has no tachypnea (RR =35-45) but chest retractions( sub costal and supracostal) with noisy breathing. Distress increases while feeding often leading to desaturation requiring oxygen Chest x-ray is as below...Though the child has evidence of sepsis (TLC 6500; CRP 8; PC 1.11 Lacs).No murmur Clinically seems like Laryngomalcia....as subsides on lying laterally. But attendants have refused to take to any other specialists. Kindly give your expert opinion.

(Edited)

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Concluded answer

Two pathologies I can think of 1. H - type TEF . Can be ruled out with urograffin dye ingestion followed by serial xray under C-ARM. ( Also see with OG tube feeding and see for distress) 2. TTNB Supracostal retractions are suggestive of upper airway pathology. As someone has said the possibility of mucus plug although likelihood is less but it should be kept in mind as there is bilateral hyperinflation. Subcostal retractions are not always suggestive of lung parenchymal disease. Possibility of laryngomalacia also seems likely and if feeding causes distress you need to refer it to ENT for operation as it is definitely a higher grade laryngomalacia. I have included options as I have not seen the patient but you are the one managing the baby. See which fits best and do accordingly.

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Two pathologies I can think of 1. H - type TEF . Can be ruled out with urograffin dye ingestion followed by serial xray under C-ARM. ( Also see with OG tube feeding and see for distress) 2. TTNB Supracostal retractions are suggestive of upper airway pathology. As someone has said the possibility of mucus plug although likelihood is less but it should be kept in mind as there is bilateral hyperinflation. Subcostal retractions are not always suggestive of lung parenchymal disease. Possibility of laryngomalacia also seems likely and if feeding causes distress you need to refer it to ENT for operation as it is definitely a higher grade laryngomalacia. I have included options as I have not seen the patient but you are the one managing the baby. See which fits best and do accordingly.

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Topical history of laryngomalacia. Laryngoscopy under anaesthesia needed to conform

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Hours of Birth. What's spo2. Repeat CBC, micro ESRand CRP.. Wait and watch if not settlesthen 2DECHO.

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Ad ECG Echo Cardiography

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Rule out tracheo esophageal fistula

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NEED'S.. CARDIAC EVALUATION.. BLOOD CBC.. CRP

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Right side lung fields are more prominent. It may be because of unilateral bronchus obstruction due to mucus plug.

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Pleural effusion

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