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Old 08-03-2013
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Help Peds question # 5

A 2 hour old full term newborn infant is noted by the intern to be having episodes of apnea and cyanosis. A pulse oxymeter is placed which shows desaturations when the baby is feed but quickly returns to normal when he cries. Which of the following is the most appropriate and quickest way to establish a diagnosis?
A. Rubella Antibody titers.
B. Echocardiogram
C. Hemoglobin Electrophoresis.
D. Bronchoscopic evaluation of the palate and larynx.
E. Passage of catheter into the nose.
F. Passage of catheter into the mouth.
G. Chest XRAY
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Old 08-03-2013
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I would go for D!
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Old 08-03-2013
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answer E..
This NB most likely has nasal stenosis..the most easy and fasy way to Dg is placement of nasoogastric tube.....

Last edited by nora05; 08-03-2013 at 11:04 AM. Reason: error..
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Old 08-03-2013
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passage of catheter into nose
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Old 08-03-2013
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The answer is E...>passage of a nasogastric tube and you actually take an xray after to see it coiling and obstruction of passage. Laser burrowing is done for further management..I think its too late lol
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Old 08-04-2013
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Wink Excellent!

Good Job, correct answer is E.

IT is important to make the correct diagnosis on these cases, specially of choanal atresia because it responds to prompt treatment but it can be lethal if left undiagnosed. Most Neonates are obligate nose breathers and cannot breathe adequately through their mouth, infants with choanal atresia have increased breathing difficulty during feeding and sleeping and improved respirations when they cry because they suck air in with their mouths. A quick and reliable method to diagnose this is by introducing a catheter through the nose or by checking for fog developing under each nostril (the fog would mean air is actually circulating) .

The other options would help diagnose different conditions that are also associated with dyspnea, however sickle cell doesnt present this early because of HbF still present on the circulation, Treacheoesophageal fistula would be present in someone with Polyhydramnios and distended abdomen.

Good job guys!
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