5-week old male, ex 37-week male, with a cough and congestion for 3 days PTA. The patient developed decreased PO and difficulty breathing so was brought to our ED. In the hospital, the patient developed respiratory distress, bronchiolitis, pneumonia, hypoxia. He had retractions (subcostal and suprasternal), head bobbing, nasal flaring.
The patient had this course:
FEN/GI: Initial sodium low at 129. The patient was given 20mL/kg NS in ER and started on D5 1/2NS +20KCl at maintenance. Repeat Na 134. Oral intake improved during admission, kept NPO for respiratory distress.
CVS/Resp: Patient hypoxic in the mid to high 80s, started on 2L. Oxygen titrated to keep >92%, currently on 2L, satting 100%. The patient was admitted with head bobbing, nasal flaring, and subcostal retractions, initially not tachypneic. He was started on hypertonic saline nebs with albuterol prior q2 hours x 3 doses, then q4 hours x 5 doses, then q 6 hours. CXR on admission normal. The patient developed worsening respiratory distress with tachypnea in the 80s, continued head bobbing, flaring, and retractions. CXR on the day of transfer showed significant right airspace disease and mild left airspace disease. VBG pending. Given his tachypnea and level of distress, we will transfer to LL for a higher level of care.
Heme/ID: Patient initially afebrile. Developed temperatures of 102 first day of admission. UA, UCx negative, BCx NGTD. Fevers persisted, so CXR, CBC, CRP, and procalcitonin done. Bands initially 19, now 24. WBC normal. Platelets initially 580 now 670. Procalcitonin 0.29, CRP 79 mg/L. The patient is given a dose of ceftriaxone this AM 50 mg/kg. The patient appears to now have pneumonia complicating bronchiolitis.
Was transferred to a tertiary center for a higher level of care. His brother was also admitted for and treated.