Case 1: Infant with Hypoglycemia and Midline Defects in Heart Failure

Presentation

A male infant is born at 37 weeks’ gestation, with a birthweight of 2,915 g (∼6th percentile on the World Health Organization growth curve, Z score = −1.53) to a 22-year-old gravida 5, para 1 woman, who has a history of 4 spontaneous abortions. After an uneventful prenatal course, the neonate is brought to our NICU 16 days after birth because of concern about dysmorphic features, poor feeding tolerance, and respiratory distress. At the transferring institution, he had received nasogastric tube feedings because of intermittent hypoglycemia and desaturations, with episodes of tachypnea during oral feeding attempts. He had been placed on nasal cannula at 13 days after birth because of his worsening respiratory condition. At the time of transfer, his oxygen saturation is good on high-flow nasal cannula and he is tolerating full enteral nasogastric feeds.

Shortly after transfer, the infant’s respiratory requirements escalate, including the need for ventilator support for suspected pulmonary hypertension, which improves after …