Following 2 days of cough and congestion, an otherwise healthy full-term 5-week-old neonate developed difficulty breathing and apnea requiring cardiopulmonary resuscitation. He was transported to a local emergency department. Following a difficult orotracheal intubation with multiple attempts, the infant was transferred to a pediatric intensive care unit with a presumptive diagnosis of bronchiolitis. During the next 2 days, he was weaned off mechanical ventilation and received oxygen via the nasal cannula. He began feeding orally and was transferred to the general inpatient floor. At the time of transfer, the patient was noted to have choking with feeds as well as a large volume of clear oral secretions that required frequent suctioning. Based on these clinical findings, oral food and fluids were withheld from the patient and a fluoroscopic video swallowing study (FVSS) was performed (Figure 1 and Video).
Shaughnessy EE, Towbin A, Prosser J. Neonate With Choking. JAMA Pediatr. 2015;169(3):281-282. doi:10.1001/jamapediatrics.2014.2910