Feeding Intolerance in an Infant

Danielle Kinsey; Chaitanya Panchangam

doi:10.1542/neo.21-7-e499

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Question

A 9-week-old male infant born at 30 weeks’ gestation has significant respiratory distress associated with desaturation and bradycardia during and after oral feedings. These symptoms resolve without any need for supplemental oxygen. During these events, the patient is not excessively irritable. After viewing the patient’s echocardiogram (Video 1), a still image of Video 1 (Fig 1), color Doppler ultrasound scan of the heart (Video 2), and Doppler interrogation (Fig 2), what is the most likely cause of this infant’s respiratory distress?

A. Bronchopulmonary dysplasia
B. Persistent pulmonary hypertension of the newborn
C. Anomalous left coronary artery from the pulmonary artery
D. Aortic stenosis
E. Atrial septal defect

Figure 1.

Still image from the patient’s echocardiogram in apical view. Left atrium, left ventricle, right ventricle, aortic valve and proximal part of ascending aorta are visualized.

Figure 2.

Doppler waveform in the ascending aorta of the patient.

Discussion

Video 1 shows a clip from an echocardiogram of this 9-week-old infant, which shows the heart in the apical 5-chamber view. By placing the transducer on the apex of the heart and moving it slightly counterclockwise with an upward tilt, the aorta (considered the fifth chamber) and the aortic valve are visible. The structures seen in Video 1 are labeled in Fig 3 and demonstrate that the patient has severe aortic stenosis with thickened valve leaflets and mild left ventricular hypertrophy. Video 3, in comparison, demonstrates a normal heart with normal left ventricular wall thickness and a normal aortic valve.

Video 1.

Click here to view the video. Echocardiogram clip of the 9-week-old infant.

Video 2.

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