Authors: Nicola McDonald, Cara Jennings / Editor: Maya K Naravi / Reviewer: Raja Shahid Ali, Ciaran Mackle / Codes: CP2, RC4, RC5, SLO5Published: 20/03/2023

A 9-week-old female infant presents to Paediatric A&E at 2200 hrs with a history of coughing, difficulty in breathing, lethargy and reduced feeding.

She has been unwell for the last 16 days with cough and difficulties breathing and this is her 4th attendance to A&E for this problem. On previous occasions she has been assessed as having a viral infection; reassured and discharged. She had a normal chest x-ray last week.

Tonight her mother reports increasing bouts of coughing and that she is more lethargic. Her mother says she stopped breathing after one of the coughing bouts earlier today and turned blue with dusky lips before recovering. There is no associated fever. She is still feeding on the breast but can only fed for short periods of time before she becomes too breathless. She has only had one wet nappy today.

She was born at term. Birth weight 3.45kg. She has two older siblings, aged 11 yrs and 2 yrs, who have colds at present. Weight today is 5.40kg.

On examination, she is alert but looks tired. Sats 100% in room air, HR 182/min, RR 45/min, CRT < 2 sec. She coughs frequently. Heart sounds are normal with good pulses, auscultation of her chest reveals good bilateral air entry with no crepitations or wheeze heard.

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