Am. J. Respir. Crit. Care Med.,
Volume 164, Number 7, October 2001, 1161-1164
Respiratory Flutter Syndrome
An Underrecognized Cause of Respiratory Failure in Neonates
ELIOT S.
KATZ,
ESTELLE
GAUDA,
THOMAS
CRAWFORD,
FOLASADE
OGUNLESI,
MAUREEN A.
LEFTON-GREIF,
SHARON
McGRATH-MORROW,
and
CAROLE L.
MARCUS
Eudowood Division of Pediatric Respiratory Sciences, Division of Neonatology, and Division of Neurology, Johns Hopkins University,
Baltimore, Maryland
We report the clinical and respiratory data of three neonates with
flutter of the diaphragm and intercostal muscles, presenting soon
after birth with respiratory failure. The breathing pattern was dirhythmic with superimposed frequencies, one regular and slow
(60/min) representing the underlying respiratory rate, the other
fast (> 300/min) and limited to inspiration. Nasal continuous positive airway pressure immediately normalized the breathing pattern in one infant, and improved ventilation in the two others. Pharmacologic therapy with chlorpromazine terminated the respiratory flutter and permitted weaning of ventilatory support within a few hours. Coexistent dysphagia suggested a disorder of brainstem function, although the children were otherwise developmentally normal at 8, 10, and 26 mo old. Laryngomalacia and gastroesophageal reflux were also present. We propose that the occurrence of
respiratory flutter, dysphagia, laryngomalacia, and gastroesophageal reflux in a neonate constitutes a distinct clinical entity,
termed the "respiratory flutter syndrome." The diagnosis of three
infants with this presentation during an 18-mo period suggests
that this may be a more frequent cause of respiratory failure in
newborns than previously recognized.
