Case 1: Acute Respiratory Failure in a 1-month-old Girl

Tara Glenn; Anne Kim Mackow; Jill Shivapour; Moira Crowley

doi:10.1542/pir.2017-0141

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Tara Glenn, MD*
Anne Kim Mackow, MD, MPH^†
Jill Shivapour, MD*
Moira Crowley, MD*

^*Department of Pediatrics and
^†Department of Pediatric Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH

AUTHOR DISCLOSURE
Drs Glenn, Mackow, Shivapour, and Crowley have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

EDITOR’S NOTE

It is good to be thankful. Whether in mindfulness training, historical contexts, or religious beliefs, the values of gratitude are widely espoused. Last month, readers in Canada celebrated a national day of Thanksgiving, and, this month, readers of Pediatrics in Review in the United States are celebrating Thanksgiving.

There is much for which to be thankful. Some gratefully celebrate personal blessings and accomplishments, while others are thankful for the provision of food, water, and shelter. Getting even more basic, we can be grateful for airways, breathing, and circulation. In this month’s Index of Suspicion cases, we follow the thought processes of clinicians helping children with altered respiratory statuses. Continuing to update our medical knowledge and skills, we provide care for which our patients and their families can be grateful.

Philip R. Fischer, MD

Associate Editor, Index of Suspicion

Presentation

A 1-month-old girl presented to the emergency department with respiratory failure. She was a full-term infant born after an uncomplicated pregnancy and delivery requiring no resuscitation. At 30 hours of life she had a choking spell with a feed and was transferred from the maternal ward to the NICU. A chest radiograph was performed and showed vertebral body segmentation anomalies in the thoracic spine, clear lung fields, and a nasogastric tube in the stomach. An echocardiogram demonstrated an atrial septal defect, a ventricular septal defect, and a bicuspid aortic …