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American Academy of Pediatrics
Index of Suspicion in the Nursery

Case 3: A Rare Cause of Respiratory Distress and Excessive Salivation in a Term Infant

Jubara Alallah, Abdulaziz Alkhotani, Ghassan Baslaim and Zanoubia Darwich
NeoReviews April 2019, 20 (4) e229-e232; DOI: https://doi.org/10.1542/neo.20-4-e229
Jubara Alallah
*Neonatology Section, Department of Pediatrics, Ministry of National Guard–Health Affairs, King Abdullah International Medical Research Center and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Abdulaziz Alkhotani
†Department of Pediatrics, and
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Ghassan Baslaim
‡Department of Cardiothoracic and Vascular Surgery, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
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Zanoubia Darwich
†Department of Pediatrics, and
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A female infant is born at 39 weeks’ gestation via normal vaginal delivery to a 22-year-old primigravida woman. The woman's pregnancy had been uncomplicated. Antenatal ultrasonography findings are normal. Results of her perinatal toxoplasmosis, rubella, cytomegalovirus, and herpes simplex (TORCH) infection tests are negative, and group B Streptococcus screening result is negative. The membranes rupture just before delivery. Significant finding at delivery includes a meconium-stained amniotic fluid. The infant is vigorous at birth, with Apgar scores of 7 and 9 at 1 and 9 minutes, respectively, and a birthweight of 3,550 kg. She is sent to the normal nursery with her mother in good condition; 2 hours after birth, she develops respiratory distress with desaturation, and is immediately transferred to the NICU for further evaluation and treatment.

The infant is given continuous positive airway pressure of 5 cm H2O. Fraction of inspired oxygen (Fio2) is 50%; temperature 36.8°C; heart rate 130 beats/min; respiratory rate 70 breaths/min; and oxygen saturation 94%. Her blood pressure is 73/49 mm Hg.

On physical examination, she is awake and alert, has no dysmorphic features, and chest examination shows respiratory distress with intercostal retractions and diffuse inspiratory and expiratory wheezing. She is also noted to have excessive salivation. No significant organomegaly is found on abdominal examination, and the rest of the systemic examination findings are within normal limits. A blood culture specimen is obtained, and empiric treatment is started with ampicillin and gentamicin. Initial blood gas measurement reveals respiratory acidosis: pH 7.18, Pco2 69 mm Hg (9.18 kPa), and bicarbonate 25 …

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Vol. 20, Issue 4
1 Apr 2019
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Case 3: A Rare Cause of Respiratory Distress and Excessive Salivation in a Term Infant
Jubara Alallah, Abdulaziz Alkhotani, Ghassan Baslaim, Zanoubia Darwich
NeoReviews Apr 2019, 20 (4) e229-e232; DOI: 10.1542/neo.20-4-e229

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Case 3: A Rare Cause of Respiratory Distress and Excessive Salivation in a Term Infant
Jubara Alallah, Abdulaziz Alkhotani, Ghassan Baslaim, Zanoubia Darwich
NeoReviews Apr 2019, 20 (4) e229-e232; DOI: 10.1542/neo.20-4-e229
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More in this TOC Section

  • Case 2: An Inguinoscrotal Swelling in a Neonate at Birth: It’s Time to Expect the Unexpected
  • Case 1: Case of Lactic Acidosis in a Term Neonate
  • Case 3: Case of a Drooling Infant
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