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Difficulty breathing in a 2-month-old infant

Prepared by...
Virat Sirisanthana, M.D.
Department of Pediatrics, Faculty of Medicine, Chiang Mai University
Chief Complaint and Present Illness:  A 2-month-old female infant had a 7-day history of subacute onset of difficulty in breathing. She was born in the community hospital without any complication. Her birth weight was 3350 grams. She had been healthy until this illness. Her mother denied any history of fever. At the community hospital she had respiratory distress so she was intubated and refered to our hospital with intravenous penicillin G. 
Family History : was not available at the time of admission
Physical examination:
GA:  BW: 4050 grams, was intubated, not pale, no jaundice
VS: T= 38.4 C (max), RR= 60/min, P = 160/min,
Anterior fontanelle 1.5 x 1.5 cm., not bulging
Lung: she was on respirator
Abdomen: liver 2 cm below RCM , spleen 2 cm below LCM.

Laboratory Findings:
Complete blood count: Hemoglobin 9.3 g/dl, hematocrit  29 % , platelets 174,000, WBC 18,500,  differential: 62 % polys , 38 % lymphocytes.
Electrolyte: Na 131 , K 3.8 , Cl 106 , CO2 22 mEq/L,
BUN 9 mg% , Cr 0.4 mg%
Chest radiograph: (see below).

CXR-d7-of-ds-sm.jpg (9257 bytes)
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