Gastroesophageal Reflux Disease in a One-Week-Old Infant Presenting With Cyanosis and Respiratory Distress

Gastroesophageal reflux (GER) is a common occurrence in infancy and early childhood. While GER is considered physiologic, gastroesophageal reflux disease (GERD) can result when extensive GER leads to troublesome symptoms such as choking, gagging, vomiting, refusal to feed, and poor weight gain. In extreme cases, GERD can cause severe respiratory complications such as apnea and aspiration pneumonia. We present the case of a one-week-old Amish female who had no prenatal care and presented with severe hypoxemia, tachypnea, and costal retractions. Further history from the family revealed persistent irregular breathing, sweating during feeds, and episodic perioral cyanosis. The patient required stabilization in the intensive care unit and received an extensive workup to rule out sepsis, cyanotic heart disease, other infectious etiologies, and other common causes of respiratory distress. The patient underwent a modified barium swallow study and was diagnosed with aspiration pneumonitis resulting from GERD and oropharyngeal dysphagia. Infantile cyanosis and respiratory distress can be manifestations of a variety of underlying illnesses. Once common causes of cyanosis have been excluded, GERD or disordered feeding should be considered as a potential etiology.