Term Infant With Respiratory Distress and Desaturations

Alice Hensley; Bernardo Kracer

doi:10.1542/neo.14-2-e100

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The Case

On day 2 after birth, a term male infant began having episodes of tachypnea and oxygen desaturation to 60% to 70% during feeding, which self-resolved after removing the nipple. A chest radiograph showed a hazy opacity in the right lower lung field. Physical examination revealed an unlabored breathing pattern with equal air entry in all lung fields. (Figure 1).

Figure 1.

Figure 2.

Right lung multicystic lesion.

Figure 3.

Right lung cystic lesion, with possible feeding vessel (anterior view).

Figure 4.

MRI repeated at 34 weeks’ gestation showed minimal regression of the mass, with continued multicystic appearance but no definitive mass effect (posterior view).

Prenatal and Birth Histories

Male infant born at 39 2/7 weeks’ gestation to a 32-year-old gravida 1 para 0 mother who had a history of hypothyroidism
Delivered via scheduled cesarean with vacuum assist
Cyanotic at delivery but cried immediately. Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Warmed, dried, and stimulated only with good response in color and tone
Birthweight: 3,280 g
Prenatal laboratory evaluation: blood type O, Rh-positive; antibody screen–negative; rapid plasma reagin nonreactive; rubella immune; positive for group B Streptococcus

Case Progression

The patient was not to have anything by mouth, but he continued to have frequent oxygen desaturation episodes without associated respiratory distress.