Case 3: Case of a Drooling Infant.

A 935-g girl with intrauterine growth restriction is born at 29 weeks and 5 days of gestation to a 26-year-old gravida 6, para 2 woman. The pregnancy is significant for chronic hypertension treated with hydralazine, and labor is induced for preeclampsia which is diagnosed on the day of delivery. Intrapartum magnesium and betamethasone are administered and cesarean section is performed for nonreassuring fetal heart tones. The neonate’s Apgar scores are 5 and 8 at 1 and 5 minutes, respectively, and she requires continuous positive airway pressure for tachypnea, retractions, and desaturations. Her clinical condition improves in the NICU and she is weaned to room air by day 8 after birth. She tolerates fortified nasogastric feeds well until 6 weeks after birth when she is found to have repeated choking and gagging episodes with copious oral and nasal secretions. Omeprazole and glycopyrrolate are started on days 54 and 59 after birth, respectively, with no significant improvement. Serial head ultrasonography scans are normal and a brain magnetic resonance imaging (MRI) scan shows an asymmetric maxilla but normal brain structure. She is transferred to our institution on day 66 after birth for further evaluation …