Diagnostic Difficulties in a Case of Neonatal Respiratory Distress

Abstract

PURPOSE: Neonatal respiratory distress is any difficulty in breathing during the first 28 days of life. Clinical manifestations include a wide range depending on gestational age and its triggering causes. METHODS: we present the case of a newborn who manifested respiratory disorders due to intermittent intracranial hypertension, a case involving difficulties in establishing an accurate diagnosis and prognosis. RESULTS: eutrophic term newborn, (birth weight 3500 gr, 39 weeks of gestational age) derived from monitorised pregnancy, birth by caesarean section, Apgar score 10 at 1 and 5 minutes. The clinical course was marked by progressive neurological and respiratory alterations, the newborn presenting laryngeal stridor, bradypnoe (20-30 breaths/minute), desaturation (70%), oxygendependency, seizures, apnea, vocal cord paralysis, requiring respiratory assistance. Neurological symptoms were characterised by cerebral cry, rowing movements, pedaling movements, generalized musculary hypotonia, drowsiness alternating with periods of marked psychomotor agitation, oral automatisms, vertical nystagmus. Laboratory examination revealed respiratory acidosis, normal chest X-ray, scratchy brain substance and high resistivity indices on anterior cerebral artery at transfontanellar Doppler ultrasound. Cerebrospinal fluid was hypertensive and MRI revealed a large left sylvian sulci and raised the suspicion of poly-microgyria. EEG was amended. Therapeutic plan included: oxygenation and SIMV ventilation, respiratory physiotherapy, fluid and metabolic rebalance, anticonvulsants, depletives, enteral nutrition by gavage, neuroroborants. In evolution, respiratory support was required for four weeks, sucking-swallowing coordination difficulties led to feeding difficulties, possibility of bottle feed accured after 6 weeks. The neurological status remained altered. CONCLUSIONS: Difficulty of establishing the etiology of respiratory distress led to the need for complex multidisciplinary investigations enabling the correct treatment and long-term projection of a realistic prognosis.