Tachypnea and Epistaxis in a Full-term Infant

Daniela Titchiner; Priya Dukes; Rebecca Speier; Sharla Rent

doi:10.1542/pir.2019-0275

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Daniela Titchiner, MD*
Priya Dukes, MD*
Rebecca Speier, MD*
Sharla Rent, MD*

^*Duke University Hospital, Durham, NC

Address correspondence to Daniela Titchiner, MD, Department of Neonatology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27710. E-mail: daniela.titchiner{at}duke.edu

AUTHOR DISCLOSURE
Drs Titchiner, Dukes, Speier, and Rent 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.

Case Presentation: Tachypnea and Epistaxis in a Full-Term Infant

A 3.8-kg male infant is born at 40 weeks’ gestation to a 30-year-old primigravida woman via normal spontaneous vaginal delivery. The pregnancy is uncomplicated, with appropriate prenatal care. Delivery is uneventful; the patient receives routine delivery care with Apgar scores of 7 at 1 minute and 9 at 5 minutes. The infant is transferred to newborn nursery with no complications. At 19 postnatal hours, he develops persistent tachypnea and stertor. The patient’s nares are suctioned bilaterally, followed by frank epistaxis and 2 episodes of bloody emesis. As a result, he is admitted to the NICU due to concern for respiratory distress and evaluation of bloody emesis.

Initial examination in the NICU reveals an appropriate for gestational age term infant with mild tachypnea with RR 80, no increased work of breathing, saturating > 97% on room air. Chest radiograph demonstrates no abnormalities. The results of a complete blood cell count and coagulation studies are within normal limits. The examining NICU physician notes a soft-tissue mass in the left nasal meatus, without facial asymmetry or visible oropharynx abnormality noted. Pediatric otolaryngology (ENT) department is consulted and via flexible fiberoptic laryngoscopy visualizes a “soft, pink, mass in the …