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NeoReviews Vol.7 No.12 2006 e627
© 2006 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.


   Case Presentation
 
A 24-day-old infant who was born at term presents at the emergency department with jaundice and feeding intolerance. He had been born to a 24-year-old gravida 3 para 2 woman via elective cesarean section due to placenta previa. Maternal serology test results were negative. Apgar scores were 9 at both 1 and 5 minutes. Infant and mother were discharged from the hospital 4 days after birth.

At 2 weeks of age, the mother noted that the infant’s sclerae were icteric. They missed their first well-baby evaluation appointment. On postnatal day 19, the baby began to have nonbilious emesis with every feeding of 20-kcal formula. Three days later, the mother noted that the baby was sleeping more, and she brought him to the emergency department the next day.

The mother reports that the infant has no history of fever, rash, diarrhea, or medications, and his stools are green pigmented. Physical examination reveals a bulging fontanelle and jaundice. Laboratory findings include hypoglycemia, thrombocytopenia, conjugated hyperbilirubinemia, elevated liver function tests, and a cerebrospinal fluid latex agglutination test positive for Escherichia coli or Neisseria meningitidis. Intravenous fluids, ampicillin, and cefotaxime are initiated, and the baby is transferred to a tertiary care center the following day.

Physical examination findings at the tertiary care center include: weight, 4.29 kg; length, 52 cm; head circumference, 36 cm; heart rate, 130 beats/min; respiratory rate, 48 breaths/min; oxygen saturation, 100% on room air; and a heelstick glucose measurement of 87 mg/dL (4.8 mmol/L). The infant has nondysmorphic facies, a wide and full anterior fontanelle, icteric sclerae, no cataracts, no goiter, and no macroglossia. Lungs are clear to auscultation, and heart examination reveals a 2/6 systolic . . . [Full Text of this Article]

Mary Joan Marron-Corwin, MD
Elizabeth Ford, MD

Division of Neonatology, St Vincent’s Medical Center, New York






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Copyright © 2006 by the American Academy of Pediatrics.