European Journal of Molecular & Clinical Medicine

Abstract

CASE:
Baby 1-week-old boy born at 37 weeks’ gestational age through spontaneous vaginal delivery. The pregnancy was complicated by maternal gestational diabetes mellitus and pre-eclampsia. The Apgar score was 9 at both 1 minute and 5 minutes after birth. Because of hypoglycemia at delivery that required IV dextrose, he was admitted to the neonatal intensive care unit. His blood glucose levels quickly stabilized, dextrose administration was discontinued, and the patient began breast-feeding. On day 2 of life, the patient began having intermittent oxygen desaturation, with oxygen saturation as measured by pulse oximetry down to 70% while sleeping; Aside from the hypoxia, he was otherwise asymptomatic. He was breast-feeding without difficulty and had no vomiting or gastroesophageal reflux; no cyanosis, stridor, or snoring; and no seizure-like activity or hypertonicity.
Physical Examination:
Baby’s temperature was 36.7 C, heart rate was 112 beats per minute, blood pressure was 70/45 mm Hg, respiratory rate was 36 breaths/min, and oxygen saturation was 99% on room air with the patient awake. He was well nourished with no acute distress. His pupils were equal, round, and reactive to light. He was normocephalic, and the anterior fontanelle was open, soft, and flat. The lungs were clear to auscultation bilaterally, with no retractions or adventitious sounds. The heart had a regular rate and rhythm with no murmur. Normal peripheral perfusion was seen. There was normal muscle tone, strength, and range of motion throughout. The abdomen was soft and not tender or distended, and no organomegaly was present.
Diagnostic Studies:
Head ultrasonography, echocardiography, and chest radiography results were all negative. A sepsis workup, including complete blood count, electrolyte panel, and blood culture, was negative. Six-hour polysomnography was performed to further evaluate the desaturation during sleep. Monitoring included electroencephalography, electromyography, electrocardiography, respiratory inductance plethysmography, thermistor, pressure transducer airflow readings, pulse oximetry, and end-tidal CO2 monitoring.