4-Month Old with Recurring Pneumonia, Rapid Breathing, Oxygen Sat in 80's
I have a 4-month old son who is in the hospital for the 3rd time since June 10, 2005.
First time he was admitted for having a cough, low oxygen saturation, Dr. though he had whooping cough, he didn't. DX with bronchiolitis. Was on low dose albuterol in tent then on inhalers, released after 4 days. Still had respiratory rate about 60 per minute with slight retractions.
2nd time in hospital was for 9 days. DX with Pneumonia. Dr saw atelectisis? Still continued with rapid breathing. Treated with low dose albuterol in tent for 12 hours. Only time in his life that he seemed to be breathing "normal". RR went back to 50-60's within a couple hours. Needed 02 when sleeping. Was ok on Room air while awake. Sent home with oxygen to use while sleeping.
This time brought to ER with RR at 100 (our count) and fever. Negative for CF. Negative for RSV, Whooping Cough. Positive for Microplasmic Pneumonia. Think there may be reflux issues? Upper GI was normal, Video Swallow Ok, X-rays look ok but "dirty". Dr's aren't sure of what is happening. He is seeing a pulmonary specialist now. He first recommended a lung biopsy but thinks baby is in good spirts and seems to be doing better. Sounds "crackly" still. Treated with Zythromax and being given Qvar and something like albuterol but with no cardiac side effects. His heartrate was going up to 240 the first couple days in the hosptial. RR is now averaging 50's. Has pulseox of 88 when sleeping and not on O2. Baby has always breathed faster than normal and had slight retractions since birth. We thought it was normal.
This is a difficult problem. It could be from lots of different causes ranging from an immune problem; to a heart problem; to a lung problem, maybe even asthma. Having a pediatric pulmonologist who sees these types of problems all the time is the best step to take to determine the cause and work to deal with it.
This is a good writeup for Mycoplasma pneumoniae infection.
According to this article, race can be a factor in severe M. pneumoniae infections:
Patients with sickle cell disease or related hemoglobinopathies are at increased risk for severe M pneumoniae infections and may develop large pleural effusions and marked respiratory distress. Those who develop extremely high cold agglutinin titers may experience digital necrosis. Since sickle cell disease and other related hemoglobinopathies are more common among African Americans, severe complications of mycoplasmal infections also occur more frequently in this group of patients."
Is your child African American? If so, has he been tested for sickle cell disease or trait? There is a rapid sickle cell test that can easily be done. To test for trait, a test called hemoglobin electrophoresis would have to be performed. I'm not sure if the rapid test will pick up trait. If your child is not African American, then this is moot, but I thought I would put it to your attention, as this paragraph appears in the middle of the article.
The article also says this:
"M pneumoniae infection is uncommon in the first year of life; however in neonates, it may cause severe disease."
Your child is in this age range. I would question the docs further about the M. pneumoniae infection. I would also ask about getting a pediatric infectious disease specialist on board, also.
I've had a couple of M. pneumoniae infections in my life: one as a teenager and another back in 1991. I was pretty severely ill both times. This organism is not to be taken lightly.
Just an update. My son was hospitalized again for Mycroplasmic Pneumonia. He still has the rapid breathing. The Dr thinks the second time he had the Pneumonia it didn't clear up. We were supposed to see the Pulmonologist but he was hospitalized again. He is home now but we don't have the Pulmonology appointment until Sept 6. I'm scared there will be a hospitalization again before that. Hopefully not. Does anyone know of any good Pulmonologist in California? This last time he was hosptialized for 4 days and the last night he was able to sleep without oxygen and his sat level was between 94-98. He is still supposed to stay on the oxygen at home though when he sleeps. I hope we get some answers soon. This is so exhausting. He is doing well right now so I'm crossing my fingers. He is on Pulmicort 2x a day and Xopenex every 6 hours. He was on zithromax for 10 days.
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