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PEDIATRICS Vol. 101 No. 1 January 1998, pp. 120-124

EXPERIENCE AND REASON:
Congestive Heart Failure in a Neonate Secondary to Bilateral Intralobar and Extralobar Pulmonary Sequestrations

The first 300 words of the full text of this article appear below.

    INTRODUCTION

Signs and symptoms of congestive heart failure (CHF) in a newborn include tachycardia, respiratory distress, feeding intolerance, irritability, and a weak cry. The neonate with CHF will usually have hepatosplenomegaly. Wheezing or crackles may be heard. Edema may be generalized, and a chest radiograph will usually reveal cardiomegaly. Differential diagnosis of CHF in a full-term newborn includes congenital heart disease, asphyxial cardiomyopathy, viral myocarditis, supraventricular tachycardia, diabetic cardiomyopathy, and arteriovenous malformations.

In this report we describe the first documented newborn with CHF due to a coexisting bilateral intralobar sequestration (ILS) and extralobar sequestration (ELS), and summarize the cases of bilateral sequestrations previously reported in the English literature.

    CASE REPORT

A 4117-g full-term boy was born via a spontaneous vaginal delivery to a group B streptococcus-negative 24-year-old woman. Apgar scores were 8/9 at 1 and 5 minutes. After the first 4 hours of life the patient remained tachypneic with a respiratory rate (RR) of 60 to 100 and tachycardic with a heart rate (HR) of 160 to 200. In room air the oxygen percent saturation was 100%. There were no maternal infectious risk factors, and the child was feeding well and otherwise asymptomatic. After 48 hours of observation, his RR remained at 70 to 80 and his HR remained at 170 to 190. He had a normal complete blood count and chest radiograph. The patient was discharged and was seen daily without resolution of the tachypnea or tachycardia and without developing any signs of sepsis. On the eighth day of life, in addition to his tachypnea and tachycardia, his liver was noted to be palpable 4 cm below the right costal margin. He was then admitted for observation and an evaluation by pediatric cardiology for suspected CHF.

On admission the patient was afebrile. His weight was 4553 g; RR 68; HR 164; blood pressure---right arm 87/59; left leg 89/58, and oxygen percent saturation 97%. . . . [Full Text of this Article]


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