Male gender, born at 35 weeks of gestation, suitable for gestational age, birth weight of 2,660 g, Apgar 9-10, without pathologies in the period of immediate newborn and fed with exclusive breastfeeding
At one month of life (November 2005), the patient complained of a one-day history of cough, malaise, and postprandial vomiting.
On the way to the hospital she presented an episode of apnea, which responded to the tactile stimulus performed by the parents.
He was admitted breathing spontaneously, but with repeated respiratory pauses, which motivated his transfer to the pediatric intensive care unit (PICU).
On admission, a child was found in regular general conditions, reactive, connected, with hemodynamic stability, and isolated rales at pulmonary auscultation.
Due to a new episode of apnea lasting 40 seconds, it should be connected to invasive mechanical ventilation (IMV).
Blood glucose was normal in 37%, hemoglobin 12.4 g/dl in 6,470 patients, hematocrit 24 mm3, (segmented 29%), bacilliforms 0%>, lymphocytes 59%>), leukocytes count was normal in 2470 patients.
The ultrasound scan showed no abnormalities.
On admission chest X-ray, a bilateral alveolar interstitial infiltrate was evident, with no images of consolidation or effusion.
The study of ADV by viral isolation and IFI, RSV, Flu and paraFlu by IFI, and Bordetella pertussis by DFA was negative.
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Empirical treatment was initiated with cefoxime and ampicillin.
The patient was discharged with an increase in ventilation parameters and a need of 02 with a 100% Fi02. The patient remained with a tendency to respiratory acidosis due to several obstructions.
Due to the severity of the patient's condition and the suspicion of a viral etiology, a viral and extensive study was requested, including hMPV screening.
In tracheal aspirate (TA) obtained on the seventh day of hospitalization, CMV was sought by rapid viral isolation technique {shell vial), ADV by cell culture technique and IFI, VRS by quantitative culture of Chlamydiacystis j trachomatis and Chlamydia trachomatis.
From the bronchial secretion obtained, a fragment of the N gene of hMPV was amplified by real-time PCR (RPC-LC)10.
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On the eighth day of evolution, the patient experienced deterioration, with bradycardia and hypotension, which responded to volume intake.
A new chest X-ray showed multifocal alveolar involvement, bilateral hyperinflation, with no evidence of effusion, and an echocardiogram that showed no abnormalities.
It was decided to add and treat the initial treatment, changing later to the tape.
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After 10 days of evolution, she was extubated after completing 10 days of cefoxime and five days of gestation, without respiratory pauses or apneas for two days.
The contribution of 02 was suspended on the third day after extubation, remaining in good general condition and without respiratory distress.
The control chest X-ray showed bilateral interstitial images, somewhat more confluent in the left paracardiac area.
She was discharged with outpatient physiotherapy due to persistent wet signology.
Due to the recurrence of cystosis during an outpatient physiotherapy session and the presence of atelectasis in the left upper lobe and bilateral interstitial infiltrate, the patient was rehospitalized.
On this new occasion, the IFI for ADV, VRS, Flu and paraFlu were negative.
After an observation period, the patient was again discharged.
He continued presenting respiratory pauses so a polysomnographic and metabolic study was carried out with normal results.
To rule out cystic fibrosis, a genetic study was requested, which was normal.
Bronchial hyperreactivity was detected in outpatient controls and treated with inhaled corticosteroids.
The weight-height and psychomotor development is currently normal for their age.
