An Unusual Cause of Respiratory Distress in a Neonate

Abstract

* Abbreviations: PICU = : pediatric intensive care unit • MRI = : magnetic resonance imaging • OR = : operating room Congenital nasolacrimal duct obstruction with cystic extension into the nasopharynx (dacryocystocele) is a rare cause of respiratory distress in the neonate. We describe the pediatric intensive care unit (PICU) course of a newborn with this disorder who had severe distress and in whom the diagnosis was originally missed. A 20-day-old female infant was admitted to the PICU after several cyanotic episodes at home. The mother stated that the child was a noisy breather since birth but that over the past 3 days labored breathing, retractions, and “dusky spells” had developed. She denied episodes of apnea. The child was a full-term infant with Apgar scores of 4 and 9 who was noted in the delivery room to have snorting respirations and retractions. Physical examination was normal except for a 3-mm ecchymotic mass noted in the left medial canthus adjacent to the lacrimal duct. The child was observed in the neonatal intensive care unit where a direct laryngoscopy was normal. Her obstructive symptoms improved and she was discharged home on day 3. On admission to the PICU, her temperature was 99.3°F, her heart rate was 138 beats per …