Respiratory flutter syndrome - An underrecognized cause of respiratory failure in neonates

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 res piratory rate, the other fast (> 300/min) and limited to inspiration. Nasal continuous positive airway pressure immediately normalized the breathing p attern in one infant, and improved ventilation in the two others. Pharmacol ogic therapy with chlorpromazine terminated the respiratory flutter and per mitted weaning of ventilatory support within a few hours. Coexistent dyspha gia suggested a disorder of brainstem function, although the children were otherwise developmentally normal at 8, 10, and 26 mo old. Laryngomalacia an d gastroesophageal reflux were also present. We propose that the occurrence of respiratory flutter, dysphagia, laryngomalacia, and gastroesophageal re flux in a neonate constitutes a distinct clinical entity, termed the "respi ratory flutter syndrome." The diagnosis of three infants with this presenta tion during an 18-mo period suggests that this may be a more frequent cause of respiratory failure in newborns than previously recognized.