Case 2: An Infant with Poor Weight Gain and Persistent Tachycardia

Abstract

An 8-week-old-term female infant presents with a 2-day history of nasal congestion, cough, and difficulty breathing. The mother denies fever and any change in feeding or wet diapers. Initial vital signs show a rectal temperature of 99.8°F (37.7°C), heart rate of 190 to 210 beats/min, respiratory rate of 70 to 80 breaths/min, oxygen saturation of 95% in room air, and blood pressure of 128/78 mm Hg. The patient is noted to be small for age (3,650 g, 7th percentile) with normal height and head circumference. She is in moderate respiratory distress with intercostal retractions but clear lungs. She is tachycardic, with good pulses and perfusion. No murmurs, gallop, or organomegaly were noted. She is administered aerosolized albuterol/ipratropium, high-flow oxygen through nasal cannula, and 20 mL/kg of normal saline bolus, with minimal improvement in cardiorespiratory status. Results of chest radiography and capillary blood gas measurement are normal. The nasal swab is positive for respiratory syncytial virus. The patient is transferred to the pediatric intensive care unit for respiratory syncytial virus bronchiolitis. Patient was born at 38 weeks to a 27-year-old gravida 3, para 3-0-0-3 mother, who reported regular prenatal care without any medical problems. The infant’s birthweight was appropriate for gestational age (3,430 g). However, after discharge, her weight gain was poor (<2 g/day) despite absence of feeding difficulty and change to a concentrated formula (25 calorie/ounce). During her admission to the intensive care unit, respiratory distress and tachycardia persist …