Recurrent migratory pneumonia in neonate

Age of the baby--- 57days

Salient features--

1. Operated case of Tracheo-esophageal fistula

2.Right vocal cord palsy with restricted movements of left vocal cord with tracheomalacia

3.Acute life threatening episodes (desaturations)

4. Excessive respiratory secrestions and Recurrent, migratory pneumonia

This female baby was born at 34 wks GA by LSCS in view of PROM and BW was 1.9kg.

She was nursed in prone position and prepared for surgery of TOF.( Color Doppler of heart showed ASD 4 mm and mild PAH)

She was operated for TOF on day 3 of life. There was a blind upper end of esophagus and there was a fistula with lower end of esophagus. Fistula was closed and anastomosis was achieved through Rt thoracotomy.

The baby was put on ventilator postoperatively. the baby was extubated on day 8 of life. The baby was noted to have copious oral secretions postop. a barium study on d10 showed passage of dye to stomach. On day 12, blood culture grew yeast and fluconazole was added.

On d13, ICD was removed and baby was stable off o2 and tolerating RT feeds.

on d17, 2 episodes of duskiness and desaturation were noted. She improved with tactile stimulation.

On d22, stitches taken for thoracotomy were removed. baby was noted to have excessive oral secretions.

She was discharged on d25 of life.

On d30, she was readmitted to hospital with cyanosis and respiratory distress. pH was 6.9 and pCo2 was 77. she improved with O2, neb and chest physiotherapy. She improved within few hours.

On d33, she was off O2 and on full feeds thru RT.

on d37, she had mild RD and was on O2.

She was noted to have stridor and direct laryngoscopy showed tracheomalacia and vocal cord palsy as noted above.

On d45, she had seizures and was started on AEDs. she was again put on mechanical ventilation.  X ray showed b/l lung shadows s/o severe pneumonia.

on d54, she was extubated and was on O2 by hood and taking feeds through RT.