Case 2: Recurrent Respiratory Distress in a Newborn

Presentation

A 2-day-old boy born without complication at 38 weeks’ gestation to a healthy mother via spontaneous vaginal delivery presented to the emergency department with 2 episodes of apnea and cyanosis after discharge from the newborn nursery. One episode had occurred during breastfeeding, and the other hours after feeding. Of note, his mother reported that a similar cyanotic event had occurred hours after the patient’s birth and improved with suctioning. In the newborn nursery he was noted to have some coughing with feeds but ultimately was deemed appropriate for discharge from the nursery without further evaluation.

On admission to the general pediatrics ward the patient continued to have episodic cyanosis and desaturations. The episodes each lasted a few minutes and seemed to resolve with suctioning of the airway. The events were often associated with oral intake but also occurred during periods of rest. Between episodes, the patient’s vital signs were within normal limits and physical examination findings were normal. Initial evaluation, including urinalysis, urine culture, complete blood cell count, blood culture, cerebrospinal fluid analysis and culture, meningitis array, chest radiography, electrocardiography, and a cardiology consult, did not reveal an etiology.

Because the cyanotic episodes seemed to be related to feeding, oral feedings were discontinued in an attempt to avoid further episodes while the diagnostic evaluation continued. Enteral feeds were to be initiated, but failure to pass a nasojejunal tube in either nostril alerted to an obstruction of the nasal passages. A computed tomographic (CT) scan of …