Pediatric Problem Solving -Case 13

Pediatric Problem Solving – Case 13
A 3 week old baby, who was full term, Is brought to the hospital. He has recently been having problems completing his feeds and today appears short of breath. On examination, his HR was 180/min, RR 72/min, rectal temperature 37.4, BP 80/50, and he had a 4 cm hepatomegaly. All blood tests were normal.
What is the most likely diagnosis:
A. Neonatal hepatitis

B. Respiratory distress syndrome

C. Heart failure

D. Congenital infection Explanation of the case:

Explaination of the case.
Infant is recently short of breath + high heart rate not in proportion with age nor temperature + high RR + hepatomegaly = heart failure ,………… Heart failure triad:
Tachypnea Tachycardia Tender hepatomegaly
His temperature is normal (37.4 - 0.5 = 36.9)
 Choice (A): will not cause all these signs
 Choice (B): points against: it is more in premature
 Choice ( C ): points with: Heart failure triad is present
 Choice (D): points against: Normal blood tests, no other symptoms associated (e.g. rubella is associated with many other problems, and many other congenital infections as well)