Noisy breathing and faltering growth in a 2-month-old infant: stertor, not stridor

A term girl was referred at 2 months of age for persistent noisy breathing noted since birth, worse with feeding and in the supine position, with brief apnoeic pauses, occasional perioral cyanosis, poor coordination of mixed breast and formula feeding and faltering growth from the 25th to the 2nd centile. She had no fever, cough or choking, and her birth and neonatal periods were unremarkable. She had previously been managed with nasal saline, nasal decongestant and intranasal steroid, without improvement.