Case history
Case history
A 10-week-old boy presents to his physician's office in January because his mother feels his breathing is labored. His pregnancy, labor and delivery were uncomplicated. His mother smoked during pregnancy and continues to do so. The family history is negative for asthma or allergy. He developed rhinitis and a tactile fever 3 days prior to presentation. Over the next few days he developed increasing cough, increased work of breathing, and decreased oral intake. On examination, his temperature is 100.4°F (38.0°C), his respiratory rate is 42 breaths per minute, and his oxyhemoglobin saturation, measured by pulse oximetry, is 93% while breathing room air. He has a wet cough. His chest exam reveals mild intercostal and subcostal retractions, scattered crackles bilaterally, and expiratory wheezes bilaterally.
Other presentations
Infants with bronchiolitis may present with apnea. This can sometimes be the sole presenting sign and is cited to occur in 1.6% to 5% of hospitalized infants. Risk factors for apnea include age <1 month in full-term infants or <8 weeks’ postconceptional age for preterm infants, lower birth weight, and the presence of any previous apneic event at presentation to the hospital.[1][2] Respiratory syncytial virus (RSV) infection can also be associated with croup. Seizures and cardiac dysrhythmias have been reported with severe RSV infection.
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