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NeoReviews Vol.7 No.3 2006 e160
© 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 2-month-old boy presents in the clinic with failure to thrive. He is currently at his birthweight of 4.4 kg, with poor feeding due to "loss of interest." He has begun having occasional episodes of nonbilious emesis, constipation, and mild polyuria. Laboratory findings include a serum calcium concentration of 18.4 mg/dL (4.6 mmol/L) and an ionized calcium value of 2.51 mmol/L (0.63 mmol/L).

Gestational history was unremarkable, but placenta previa required emergent cesarean section at 40 weeks’ gestation. Initial Apgar scores were 2 at 1 minute, 7 at 5 minutes, and 8 at 10 minutes. He experienced respiratory distress soon after birth and required mechanical ventilation for 1 day. He also had three seizures soon after birth and received phenobarbital. On the fourth postnatal day, he was noted to have firm, dark pink skin lesions on his buttocks, thighs, upper arms, and cheeks. Over time, the lesions became less reddened but remained large and firm to touch. Calcium concentrations at that time were normal. A platelet count of 22x103/mcL (22x109/L) resolved without transfusion.

Physical examination today reveals an interactive infant who makes eye contact and smiles. His tone is slightly decreased, and he is unable to suspend his head against gravity. His patellar reflexes are slightly hyperactive. He has . . . [Full Text of this Article]

Jocelyn Schiller, MD
Julia Chang, BS

University of Michigan, Ann Arbor, Mich






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