A 2 month old with cough since birth
Dr Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India
Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056
Clinical Problem :
A 2 month old boy born of non consanguineous marriage presented with cough since birth, fever and breathlessness for 4 days. There is no refusal of feeds, difficulty in feeding. There is no stridor.
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What is the cause of cough_?
Discussion :
This child has presented with cough since birth. Usually cough is not a feature in neonates. Even with a respiratory pathology such as congenital lung problems, tracheomalacia` the patients usually present with breathlessness. Cough would suggest increased pulmonary congestion. Pulmonary congestion could be due to pneumonia in which case there would be fever and progression of disease in the 2 months. Pulmonary congestion could also be due to fluid which may occur with a heart disease. Heart disease which leads to pulmonary congestion could be a congenital heart disease with left to right shunt. The present fever and breathlessness could be due to pneumonia. In this child, on examination, there was a perasternal pansystolic murmur with cardiac failure and echocardiography showed moderate size ventricular septal defect {VSD} with pulmonary hypertension and Chest X-Ray showed a right upper zone pneumonia.
E-published: August 2013 Vol 10 Issue 8 Art No. 43
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