Differential Diagnosis for Newborn Boy with Coughing and Difficulty Feeding
- Single Most Likely Diagnosis
- Tracheoesophageal Fistula (TEF) or Esophageal Atresia (EA): The patient's symptoms of coughing and vomiting during feeding, along with the presence of formula mixed with saliva in his mouth, strongly suggest an issue with the esophagus, such as TEF or EA. These conditions are congenital anomalies that can lead to respiratory distress and feeding difficulties due to the abnormal connection between the trachea and esophagus or the esophagus being underdeveloped.
- Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Although less likely given the acute presentation and severity of symptoms, GERD could cause coughing and vomiting during feeding due to the reflux of stomach contents into the esophagus.
- Respiratory Infection: The patient's coarse breath sounds and intercostal retractions could indicate a respiratory infection, which might be exacerbated by or contribute to feeding difficulties.
- Congenital Heart Disease: The presence of a grade 2/6 systolic murmur suggests potential congenital heart disease, which could lead to respiratory symptoms and feeding difficulties due to increased energy expenditure and decreased cardiac output.
- Do Not Miss Diagnoses
- Pneumonia: Although the patient's oxygen saturation is relatively preserved, pneumonia must be considered, especially given the history of coughing and coarse breath sounds. Pneumonia can rapidly progress and become severe, making prompt diagnosis and treatment critical.
- Congenital Diaphragmatic Hernia (CDH): This condition, characterized by a herniation of abdominal contents into the thoracic cavity, can cause severe respiratory distress and feeding difficulties. It is crucial to diagnose CDH early, as it requires immediate surgical intervention.
- Rare Diagnoses
- Laryngotracheoesophageal Cleft: A rare congenital anomaly where there is a cleft or split in the larynx, trachea, and esophagus, which could explain the patient's symptoms of coughing and difficulty feeding.
- Vascular Ring or Sliding Hiatus Hernia: These are rare conditions that could potentially cause esophageal compression or obstruction, leading to feeding difficulties and respiratory symptoms.