Make the Diagnosis: Spring 2018

A 10-month-old male infant was taken to CHOP Emergency Department after having an apneic episode with loss of consciousness for 60 seconds in his pediatrician’s office. The infant was born at 23 weeks gestation. He was discharged home just 3 weeks prior to this ED presentation on supplemental oxygen and G-tube feeds after a prolonged hospitalization after birth.

Approximately 2 weeks ago, he was seen at an outside ED for increased coughing, tachypnea, and sweating. At that time, he was noted to have a nonfocal chest X-ray and negative respiratory viral panel. He was treated with inhaled respiratory treatments, underwent nasal suctioning, and, per maternal report, returned to baseline. He was discharged home the same day. Over the course of the next 2 weeks, symptoms persisted, particularly surrounding G-tube feedings. Mother was in contact with outpatient Pulmonology and was initiating infant’s flare plan, which included increasing Albuterol, Atrovent®, and QVAR® treatments, and extending out the length of his G-tube feeds. On the night prior to admission, infant’s work of breathing and retractions worsened.

Upon his presentation at CHOP ED, his oxygen saturations were noted to be in the 80s, and on physical exam he had significant subcostal retractions and tachypnea.

Have you figured out this diagnosis? The correct answer is rhinovirus, viral URI or viral pneumonia, the subject of the Summer 2018 issue’s cover article.