Case 5: BRUE in an Infant Found to Have Feeding Difficulties

Presentation

A 9-week-old girl born at term presents to the emergency department after a perceived brief resolved unexplained event (BRUE) subsequent to feeding. Shortly after feeding and being placed in her bassinet, she was observed to be blue, limp, and diaphoretic, with an expression of distress. She has a long history of grunting with labored breathing after feeding. The pregnancy and birth history is normal.

Her vital signs are as follows: weight, 11.9 lb (5.4 kg); length, 24 in (61 cm); temperature, 97.7°F (36.5°C); heart rate, 171 beats/min; respiratory rate, 64 breaths/min; and oxygen saturation, 98% on a 1-L nasal cannula. Physical examination is significant for tachypnea, nasal flaring, and grunting, with scattered wheezes heard over both lungs. The results of the remainder of her examination are within normal limits.

Initial laboratory results show venous pH 7.2; carbon dioxide, 17 mEq/L (17 mmol/L); anion gap, 20 mEq/L (20 mmol/L); white blood cell count, 9.8 × 10³/μL; hemoglobin, 9.4 g/dL (94 g/L); hematocrit, 27.9%; and platelet count, 333 × 10^{6 …}