HOME HELP CONTACT US SUBSCRIPTIONS CME ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) E-Letters: Submit a response Alert me when this article is cited Alert me when E-Letters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Maghsood, S. Articles by Das, B. B. Search for Related Content PubMed Articles by Maghsood, S. Articles by Das, B. B.

NeoReviews Vol.8 No.3 2007 e133
© 2007 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.

	Case Presentation

 
A 1-week-old infant is brought to the emergency department because he has had marked respiratory distress for 2 days. He has had no fever and has not been exposed to illness. On physical examination, his temperature is 98.2°F (36.8°C), heart rate is 164 beats/min, respiratory rate is 72 breaths/min, oxygen saturation is 92%, and blood pressure is 79/41 mm Hg. On cardiovascular examination, a grade II/VI systolic murmur is audible at the left lower sternal border. Auscultation of the chest reveals clear breath sounds bilaterally, although subcostal retraction is noted. His skin is warm and well perfused. There is no hepatomegaly. The rest of his physical findings are normal.

Laboratory findings include: glucose, 76 mg/dL (4.2 mmol/L); sodium, 140 mEq/L (140 mmol/L); potassium, 4.1 mEq/L (4.1 mmol/); chloride, 115 mEq/L (115 mmol/L); bicarbonate, 20 mEq/L (20 mmol/L); blood urea nitrogen, 5 mg/dL (1.8 mmol/L); and creatinine, 0.3 mg/dL (26.5 mcmol/L). A venous blood gas reveals a pH of 7.27 with a bicarbonate concentration of 24 mEq/L (24 mmol/L), oxygen level of 36 torr, and a base deficit of –3.2 mEq/L. His white blood cell count is 9.3x10³/mcL (9.3x10⁹/L) with 58% neutrophils, hemoglobin is 14.4 g/dL (144 g/L), and hematocrit is 43% (0.43). A chest radiograph shows an interstitial pattern of opacification and borderline cardiomegaly. The patient has a full evaluation to rule out an infective cause, and all microbiologic study results are negative. An additional blood test helps in deciding the cause of respiratory distress and guiding further management.

	Case Discussion

 
     The Condition
Infants who have congestive heart failure (CHF) may develop respira-tory distress because of a respiratory infection or an exacerbation of their cardiac disease. In . . . [Full Text of this Article]

Shabnam Maghsood, MD
Bibhuti B. Das, MD

Department of Pediatrics, Kosair Children’s Hospital, University of Louisville, Louisville, Ky