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CASE REPORT
Ventilator respiratory graphic diagnosis of hiccupping in non-ketotic hyperglycinaemia
  1. Eliana Panayiotou,
  2. Kelly Spike,
  3. Colin Morley,
  4. Gusztav Belteki
  1. Neonatal Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Eliana Panayiotou, epanayiotou{at}doctors.org.uk

Summary

A neonate presented with early encephalopathy deteriorated and was intubated and ventilated. Ventilator data were monitored and recorded at 100 Hz for 24 hours.

The infant had many sudden deep inspirations during this time which were initially thought to be seizures. These were characterised by short, rapid, large inspirations when the airway pressure was reduced well below the positive end expiratory pressure level. Analysis of the ventilator data showed that these were hiccupping episodes misinterpreted by the ventilator as spontaneous breaths and triggering ventilator inflations. The expired tidal volumes during the hiccupping episodes were more than double the set 4.5 mL/kg. During these episodes, there was no change in the level of consciousness or in the amplitude-integrated electroencephalogram signal. Detailed respiratory recording of pathological hiccups has not been reported.

Metabolic screening diagnosed non-ketotic hyperglycinaemia. Hiccups commonly occur in this condition and should not be misinterpreted as seizures, spontaneous breaths or gasps.

  • neonatal and paediatric Intensive care
  • congenital disorders
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Footnotes

  • Contributors GB: collected and analysed the data. KS: provided the CFM data. EP, CM and GB: wrote the case report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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