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NeoReviews Vol.8 No.7 2007 e301
© 2007 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 15-day-old girl has abnormally shaped low-set ears, left facial microsomia, and micrognathia suggestive of Goldenhar syndrome. Magnetic resonance imaging (MRI) of the brain reveals colpocephaly, membranous cleft palate, and fluid in the left middle ear cavity. Echocardiography documents normal heart anatomy and function. The infant is feeding well and has appropriate weight gain, but she has occasional decreases in oxygen saturation during feedings. Upper gastrointestinal radiographic study shows massive reflux, prompting the administration of ranitidine and positioning with her head elevated. Despite the reflux precautions, the baby continues to have episodes of low oxygen saturation while feeding, which now occur even at rest. The episodes last for less than 1 minute and are relieved by bag-and-mask ventilation.

Twenty days after birth, she has a generalized clonic seizure. At this time, her glucose concentration is 67 mg/dL (3.7 mmol/L) and ionized calcium concentration is 2.48 mg/dL (0.62 mmol/L) on a capillary specimen, which is confirmed by a similarly low venous blood determination of total calcium of 4.3 mg/dL (1.08 mmol/L). She also develops a staphylococcal abscess in the left leg and left femoral vein thrombosis.


   Case Discussion
 
Calcium gluconate infusion resulted in resolution of the seizure. However, calcium concentrations . . . [Full Text of this Article]

Chetan Dhamne, MD
Remi Adesida, MD
Vishwanath Agrawal, MD

John Stroger Hospital of Cook County, Chicago, Ill






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