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Western States Pediatric Pulmonary Case Conference Cough, Hypoxia, and Down Syndrome

Outline. Case presentation: Cough, Hypoxia, and Down SyndromeDifferential DiagnosisMulti-system complications of patients with Trisomy 21Treatment and Monitoring. Chief Complaint. 9 month old female with Down Syndrome referred to pulmonary clinic for initial evaluation because of cough and per

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Western States Pediatric Pulmonary Case Conference Cough, Hypoxia, and Down Syndrome

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    1. Western States Pediatric Pulmonary Case Conference Cough, Hypoxia, and Down Syndrome Emily DeBoer, MD The Children’s Hospital University of Colorado September 22, 2010

    2. Outline Case presentation: Cough, Hypoxia, and Down Syndrome Differential Diagnosis Multi-system complications of patients with Trisomy 21 Treatment and Monitoring

    3. Chief Complaint 9 month old female with Down Syndrome referred to pulmonary clinic for initial evaluation because of cough and persistent oxygen requirement

    4. History of Present Illness Daily cough for months - day and night No increased work of breathing Snoring Gags with jejunal feeds Treated with Ranitidine Severe oral aversion, tastes by mouth

    5. Past medical/surgical history Trisomy 21 Born at 36 weeks in Colorado Esophageal atresia without TEF GT placment DOL 1 Gastric pull-through at 4 months On and off oxygen Ventilated x 1 week after surgery Discharged at 5 months on Ľ lpm O2 via nasal cannula

    6. PMH/PSH PDA ligation at 5 months of age Recent echo revealed – “normal function, small left to right ASD, mild TR” Monthly esophageal dilations – tolerated well

    7. Meds at visit Ranitidine Spironolactone/hydrochlorothiazide Ľ lpm oxygen No inhaled medicines No steroids

    8. Review of Systems No fevers Adequate growth No hemoptysis No vomiting No steatorrhea Normal thyroid No hematuria Sitting with support

    9. Family and Social History No asthma, allergies, or lung disease in the family Lives with mom, “adopted grandparents” in Denver Parents are from Senegal No known TB exposures No pets No smokers

    10. Physical Exam Vitals HR 136 | RR 28 | Ht 65 cm (43%) | Wt 7.5 kg (39%) SaO2 88% RA | SaO2 95% Ľ lpm General: happy baby, + drooling HEENT: Down’s facies, small nares, +rhinorrhea Chest: Easy work of breathing, clear to auscultation, prolonged expiratory phase CVS: RRR, normal S1 and S2, no murmur Abd: Soft, non-tender, no hepatosplenomegaly Ext: No clubbing Neuro: Decreased truncal tone

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