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A 3.56-kg term male infant was born by cesarean section to a 24-year-old gravida 2 para 1 mother. Prenatal screens were unremarkable. Apgar scores were 10 and 10 at 1 and 5 minutes, respectively. In the very fi rst hours of life, the newborn was noted to have nasal congestion, cough and tachypnea, increasing his work of breathing within hours. He was admitted to the neonatal intensive care unit. White cell count was normal, C-reactive protein slightly elevated (24.9 mg/L), blood cultures and nasopharyngeal aspirate were negative. Chest radiograph revealed atelectasis at the right middle lobe and dextrocardia. Echocardiogram revealed dextrocardia with open foramen ovale. Abdominal sonography confi rmed situs viscerum inversus. Antibiotics were started and administered for 5 days. He continued to have respiratory distress and required oxygen during the fi rst 8 days. Until the day of discharge (postnatal day 22), he continued to have thick nasal mucus with cough, so he required frequent nasal discharge, saline inhalations and chest physiotherapy. Nasal ciliary biopsy was also performed. Electron microscopy of the nasal cilia demonstrated qualitative and quantitative abnormalities of kinocilia, suggesting primary ciliary dyskinesia: normal 9+2 arrangement of the microtubules but with a reduced number of the outer and inner dynein arms, shorter cilia and abnormal ciliary orientation. Prior to discharge, multidisciplinary follow up was arranged.

Kartagener syndrome – a very rare cause of neonatal respiratory distress