Sir.—In the December 1975 issue of the Journal (129:1402,1975), Green et al described 16 neonates and children with diaphragmatic paralysis. In this, as well as in other reports,1-3 the paralysis was always secondary to neuromuscular disease or trauma. As no previous cases of diaphragmatic paralysis of unknown cause in infants or children have been reported, I wish to describe such a case.
Report of a Case.—A 7½-month-old girl was admitted to the hospital for severe respiratory distress of acute onset. She appeared chronically malnourished. Her breathing was gasping and irregular. The head circumference was 40 cm, and her weight was 4.6 kg. Findings from the examination were otherwise normal. She had never received immunizations. Laboratory data showed severe respiratory and metabolic acidosis. Levels of serum electrolytes, blood urea nitrogen, calcium, magnesium, phosphorus, bilirubin, alkaline phosphatase, creatinine phosphokinase, uric acid, total serum protein, serum immunoglobulins, and blood lead,