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Posted On : 04 Nov 2010

20 day old newborn presented with not able to suck and swallow feeds. mother 2nd para, 1st female normal. antenetal polyhydrominios, no other anomaly detected. delivery fullterm normal, cried soon after birth.
on day one admitted for respiratory distress dignosed as cong pneumonia, baby had persistent secretion in throat so investigated for TOF , NO fistula on plain and contrast study. barium meal suggestive of gr-3 reflux.
direct laryngoscopy by ENT no anomaly found.
vocal cord normal. pediatric surgical reference no anomaly found. CT brain- normal, physiotherapy and oromotor stimulation done no response.
at present baby had no sepsis, gaining weight, tolerates full ryles tube feeding, but need repeted oral secretion.

dr.kamal parikh
drkamal_mital@yahoo.co.in
09825024932.

Expert Answer :

Answer Discussion :

D

dody tarek

0

aspiration pneumonia

14 years ago

M

Marwa Elhodeby

0

chest infection from recurrent aspiration{pneumonia

14 years ago

P

prasanna shetty

0

H TYPE TOF

14 years ago

S

saeedelsadek

0

we should r, o sma{spinal m atrophy}, or upper git narrowing as oesoph. stricture or vascular ring, full neurological ex. is needed .

14 years ago

C

C Pradeep

0

GERD SYNDROME

14 years ago

Answer 1

It appears that the baby has been extensively investigated for the obvious anatomical causes. There is lot of evidence for possible functional anomaly of the babies with swallowing difficulties secondary to Gastro-Oesophageal Reflux or they can be present themselves in isolation. Usually these sort of babies in the western world are treated by regular speech pathologists who stimulate oro-gastric stimulation and encourage swallowing, but generally it takes few weeks to months - provided there are no other causes. The cause of concern in this baby is that you mention that this baby had Congenital pneumonia - whether the swallowing part of the brain was affected with hypoxia can be resolved only by doing MRI or PET scan later - and that could account for the problem too.

Otherwise, I am sure the baby has had NORMAL calcium, if not should be investigated with serum calcium as hypocalcaemia is well known to cause this sort of problems.

R Kishore Kumar
Consultant Neonatalogist

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