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.
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.
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.
Topical history of laryngomalacia. Laryngoscopy under anaesthesia needed to conform
Hours of Birth. What's spo2. Repeat CBC, micro ESRand CRP.. Wait and watch if not settlesthen 2DECHO.
Ad ECG Echo Cardiography
Rule out tracheo esophageal fistula
NEED'S.. CARDIAC EVALUATION.. BLOOD CBC.. CRP
Right side lung fields are more prominent. It may be because of unilateral bronchus obstruction due to mucus plug.
Pleural effusion
Cases that would interest you
- Login to View the image
What is steeple sign & in which condition it is seen
Dr. Dommeti Durga Prasad7 Likes23 Answers - Login to View the image
Image shows laryngocopy of a child with a stridor. Diagnosis?
Mansi Batra1 Like13 Answers - Login to View the image
10 months baby c/o cold since 10 days, vomiting on occasionally o/e gur gur sound's please examine the xray and boold report suggest us treatment and diagnosis. thank you
Dr. Sivakrishna M1 Like12 Answers - Login to View the image
2 months old male child having mild distress and significant sternal retractions without any other complaints. Feeding easily having good weight gain. Having sounds like laryngomalacia. O/E- no cardiac murmur HR-142/min SPO2-96%(RA) RR-49-54/min No HSM
Dr. Sunil Yadav1 Like12 Answers - Login to View the image
1.5m old infant, came with c/o jerky respiration.. o/e RR 50/min, subcostal retraction present... Mother also c/o additional sound while feeding. No fever, chest clear, S1 S2 heard, counts normal, calcium 10, ALP 818... Further workup being done.. Discuss..
Dr. Manish Verma3 Likes11 Answers
2 Likes