case17

Background

A 7-month-old black female with a history significant for failure to thrive was transported to our facility from an outlying hospital with acute respiratory failure. Her parents stated that since discharge from a previous hospitalization at 4 months of age, the infant has had multiple episodes of coughing and wheezing. On the day prior to admission, her respiratory symptoms worsened and she was started on bronchodilators. On the day of admission, she had deteriorated further, presenting with severe sternal retractions, wheezing, and decreased oral intake and activity. On arrival to the emergency department, she was assessed as being in respiratory failure with altered mental status, and was immediately intubated.


The patient was born at 37 weeks gestational age to a group B Streptococcus-positive mother. The birth weight was 6 pounds, 11 ounces (50th percentile). The infant was hospitalized at 4 months of age for respiratory syncytial virus (RSV) pneumonia and respiratory failure. This hospital course was complicated by Staphylococcus aureus sepsis and a Candida urinary tract infection. The baby lives with her parents and her 4-year-old twin male siblings. The parents stated that although the baby previously had been eating well, she had continued to lose weight despite the use of 27 calories per ounce formula. They denied the occurrence of any episodes of vomiting or diarrhea. According to the parents, neither of the patient's siblings has had any chronic medical problems, previous hospitalizations, or delay in growth. The family denied a history of recent travel out of the country or exposure to sick contacts.


Rectal temperature 98° F, pulse 180 beats/min, respiratory rate 36/min on the ventilator, blood pressure 108/54 mm Hg, SpO2 97% on 50% oxygen. Weight 4.68 kg


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