Anna, an 11-Year-Old Girl with Medical Complexity, Fever, Increased Secretions, and Increased Seizure Frequency

Abstract

CASE PRESENTATIONAnna is an 11-year-old girl with a medical history of extreme prematurity, intraventricular hemorrhage, and cerebral palsy. Her underlying diagnoses include chronic respiratory failure with tracheostomy and ventilator, severe dysphagia and reflux with gastrojejunostomy (GJ) tube, hydrocephalus with ventriculoperitoneal (VP) shunt, spasticity treated with enteral baclofen, scoliosis, and intractable epilepsy for which she is on multiple antiseizure medications (ASMs). She is nonverbal and nonambulatory. She does not take feeds or medications by mouth.Anna’s parents, along with her home health nurse, have brought her to the emergency department (ED) because of new-onset fever, increased oral secretions, poor feeding tolerance evidenced by retching, increased seizure frequency, and general discomfort. The physician in the ED notes that Anna has an increased oxygen requirement, and she has obtained basic laboratory tests and imaging prior to calling you to assess Anna for admission.