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Page 3 / Case 09/02


Mother states the pregnancy was unremarkable, however she did have some slight bleeding at 22 weeks. She was otherwise well. Mother had three ultrasounds during the pregnancy, which she was told were normal. We tried in vain to contact her obstetrician but he was off on sick leave and subsequently retired. We were unable to obtain her ultrasound reports or films from his office despite our numerous phone calls and faxes.

The child's mother states she has not had any blood transfusions in the past. The child was born vaginally at 37 weeks with a birth weight of 7lbs 3 oz. To the mother's recollection, he spend between 3 and 24 hours in the special care nursery. She could not recall if he required oxygen during this time frame. He was breast fed for the first four and a half months of life and then was switched to Enfalac with Iron untill eleven months of age. Subsequently the child was then introduced to whole cow's milk. Mother describes his appetite as good, and at present, he eats a wide variety of foods including meats. His bowel movements were between five and six a day and were generally soft. Stool color was brown-green-yellow. He did not have diarrhea or constipation. He did not complain of abdominal pain.

In retrospect mom now says he was always chronically chesty and tachypneic since birth. He has always had a chronic nocturnal cough, and had been on ventolin since three months of age. He initially was noted to choke on feeds, but improved over time. This was not investigated.

He experienced rhinorrhea with colds only. He had diaper dermitis and cradle cap that would wax and wane with treatment. Multiple creams including canestein, hydrocortisone, and cotrimazole cream were used.

He had no prior history of pneumonia, otitis media, abscess or skin infections. He had not been admitted previously to any hospital. He had not travelled out of his home province nor had any house guests from another country stay with his family. He did not have unexplained fevers, joint pains or swelling.

He was started on Fluticasone metered dose inhaler 50 mcg/puff two puffs bid with Aerochamber at 12 months of age. The salbutamol (albuterol) was continued on a prn basis and he often took two puffs four times a day via Aerochamber.

At nineteen months he was diagnosed with asthma and had an episode of bronchiolitis treated with amoxicilline. Mom brought him multiple times to the doctor for concerns about his breathing but was reassured he had asthma. The family history was positive for atopy including allergies and asthma. Parents were unrelated and from Canada. All siblings were well.

Mom was well versed in environmental precautions, and had given their pets away when he was four months of age. There were carpets in the house. She had put a mattress cover over his mattress and removed all the stuffed toys from his bedroom. The home was relatively new at six years of age, and there are no smokers in the home.

The only history of an allergic reaction is from a treatment with amoxicilline at 19 months of age, when he presented with hives. The child is fully immunized.

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