Sinusitis in an infant

SUBJECTIVE DATA Jorge S. is the third child of a 21-yearold Hispanic woman. Jorge’s mother had an uneventful pregnancy. Jorge was born at term and his Apgar scores were 9 and 10. Jorge’s birth weight was 7 lb 11 oz, and he was 21 in long. Jorge’s mother chose to breastfeed and did so for the first week exclusively Jorge was well until 5 weeks of age, when his mother brought him to the walk-m clinic with a rash on his forehead and nasal congestion. He had no fever or cough. His temperature was 97.5”. His mother was breastfeeding and supplementing her milk with formula, which is a cultural norm. Jorge was given pseudoephedrine drops for the suspected upper respiratory infection, and his mother was advised to use normal saline nose drops with nasal suction and a humidifier if possible. One week later the mother returned with Jorge to her regular pediatric nurse practitioner because of increasing nasal congestion and the rash on his forehead, which had not cleared. She had now stopped breastfeeding altogether, and Jorge was taking Enfamil with iron exclusively His vital signs remained normal with a temperature of 98.0”. His weight was 11 lb 7 oz. The rash was now clearly classic cradle cap, and the nasal congestion was still considered to be benign. Jorge’s mother was given advice about the cradle cap and advised to continue to follow the previous instructions for the nasal congestion. The mother returned with Jorge when he was 7 weeks of age because the nasal congestion had increased. She was now frustrated and felt ‘*nothing is

November/December

1998

being done” for her child. By this time the nasal congestion has increased to the point that it can be heard outside the closed examination room door. Physical examination reveals normal weight gain and vital signs, a temperature of 9&O”, and a weight of 12 lb 2 oz. Both tympanic membranes were normal, increased mucus was present in the mouth, and he had very noisy nasal congestion. His heartbeat was regular without a murmur and his lungs were clear except for considerable upper airway congestion. Jorge continued to be a happy infant. He had no nasal flaring and no retractions or increased respiratory effort, An attempt to suction the nose was entirely unsuccessful. A feeding tube was easily passed through each naris but was not helpful in clearing the congestion. The radiologist was consulted by telephone, and it was agreed that a limited computed tomographic (CT) study

of the sinuses would be done the next day. With a presumptive diagnosis of sinusitis, amoxicillin drops, 0.5 ml every 8 hours, were prescribed, and Jorge was sent home.

CLINICAL COURSE The sinus CT scan revealed that Jorge’s ethmoid and maxillary sinuses were opacified, as would be expected with sinusitis. No air was seen in the ethmoid air cells. Jorge’s mother was notified of the results of the CT scan and advised to continue using the amoxicillin as ordered. She agreed to give Jorge the medication and return at the end of the treatment for follow-up. At the return visit, Jorge was breathing quietly. His weight gain was again normal. He received his regular 2month well-child examination and immunizations. His mother was happy because he was breathing normally now and his cradle cap also was improving.

CLINICAL INSIGHTS QUIZ 1. What other diagnosis might be considered for nasal congestion in newborn infants? 2. How developed are the sinuses at birth? 3. What diagnostic tests might be pevfomedfor sinusitis? 4. What is the normal treatment of sinusitis in this age group? Answers

are on page 340.

Hazel C. Fleck is a Pediatric Reprint requests: WA 99362.

Nurse Practitioner

J Pediatr Health Care. (1998). Copyright

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Center, Walla Waila,

Wash

Center, 1120 W Rose St, Waila Waila,

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0 1998 by the National

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Hazel C. Fleck, BSN, ARNP, CPNP, Family Medical

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