Background

A 6-month-old male infant had a fourth hospital admission with respiratory distress. He was tachypnoeic and required oxygen but was orally feeding well. He was diagnosed with bronchiolitis and admitted for supportive care.

He was born at 30 weeks gestation, had required nasal continuous positive airway pressure for 10 days and was oxygen dependent for 44 days.

Viral respiratory screen was negative and had been on all but one occasion when he was respiratory synctial virus positive.

As this was his fourth presentation, a chest X-ray was taken (figure 1). No anomaly was present on neonatal films on retrospective review. He improved clinically but remained tachypnoeic with increased work of breathing. He was discharged when maintaining oxygen saturations in air and respiratory follow-up was arranged.

At 7 months of age, he presented with fever, tachypnoea and subcostal recession. He represented to Accident and Emergency three further times with increased work of breathing. His mother remained concerned that subcostal recession was …