Case 1: Persistent Tachypnea in an Infant

Daniel Hinds; Matthew Cooper; Ameet Daftary

doi:10.1542/pir.2016-0027

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Daniel Hinds, MD*
Matthew Cooper, MD*
Ameet Daftary, MD*

^*Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN

AUTHOR DISCLOSURE
Drs Hinds and Cooper have disclosed no financial relationships relevant to this article. Dr Daftary has disclosed that he has an Indiana University School of Medicine internal grant to study normative measures in neonatal sleep, is on the Indiana University School of Medicine pediatric sleep medicine CME committee, and is a volunteer member of the American Academy of Sleep Medicine's MOC committee for sleep medicine and a question writer and question reviewer of MOC and SITE examination questions for the organization. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 4-month-old boy presents to the hospital with worsening tachypnea. He was born at 34 weeks' gestation via cesarean delivery to a gravida 1 mother owing to preterm labor and cephalopelvic disproportion. After birth, he was admitted to the NICU for prematurity, feeding difficulty, and hypoxemia. He advanced to full feeds by 7 days after birth; however, by day 23 after birth, he had developed tachypnea, and auscultation of his lungs demonstrated slightly diminished breath sounds in the right upper lobe (RUL) with crackles in the left upper lobe (LUL). A chest radiograph showed RUL atelectasis with mild LUL expansion (Fig 1). Because he did not improve with chest physical therapy, a bronchoscopy with bronchoalveolar lavage was performed on day 39 after birth and did not show any airway …