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Clinical Challenge
January 2018

Worsening Respiratory Distress in a 7-Month-Old Infant

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Rady Children’s Hospital San Diego, San Diego, California
  • 2University of California, San Diego, San Diego
  • 3Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California
JAMA Otolaryngol Head Neck Surg. 2018;144(1):84-85. doi:10.1001/jamaoto.2017.2243

A 7-month-old infant presented to the otolaryngology clinic for noisy breathing. His noisy breathing had been present since birth, constant, exacerbated with feeding, sleeping, and supine positioning. He fed poorly from the bottle with frequent choking, grunting, and irritability, and had minimal weight gain with 1 cyanotic event while feeding. His medical history was significant for prematurity, born at 26 weeks, and a 60-day intubation during a 99-day neonatal intensive care unit stay. The physical examination was remarkable only for biphasic stridor and a weak cry. Nasopharyngolaryngoscopy showed no laryngomalacia, laryngeal lesions, or cord paralysis.

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