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NeoReviews Vol.9 No.1 2008 e39
© 2008 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 2,496-g male infant was born at term to a 20-year-old primiparous African American woman whose pregnancy was complicated by a primary herpes simplex virus (HSV) outbreak 9 days prior to delivery. Prenatal laboratory findings were unremarkable, including negative results for human immunodeficiency virus, syphilis, hepatitis B, and group B Streptococcus screening tests and a normal glucose tolerance test result. The mother presented to the labor and delivery unit of a community hospital with concerns about decreased fetal movement. Fetal heart rate monitoring revealed late decelerations and lack of heart rate variability, so an emergent cesarean section was performed. At delivery, thick meconium was present, and the infant had abnormally increased tone, decorticate posturing, and minimal respiratory effort. Meconium was suctioned from below the vocal cords, after which the infant began crying spontaneously. Apgar scores at 1 and 5 minutes were 5 and 8, respectively. The infant was transferred to the nursery, where pulse oximetry revealed fluctuating oxygen saturations of 80% to 90%. He was placed under an oxygen hood with an FiO₂ of 0.50 to maintain oxygen saturations greater than 90%. On physical examination, he exhibited increased work of breathing with retractions and abnormally increased tone.

At 30 minutes after birth, the infant developed overt seizure activity manifested by lip smacking, eye deviation, and tonic-clonic movements of the extremities. A dextrose stick revealed a blood glucose concentration of less than 20 mg/dL (1.1 mmol/L), so a bolus of 10% dextrose solution was administered. Hypoglycemia persisted, requiring additional boluses of 10% dextrose and administration of dextrose-containing maintenance intravenous fluids. The infant ultimately required a glucose infusion rate of 8 mg/kg per minute to maintain euglycemia. Despite blood glucose . . . [Full Text of this Article]

Benjamin Blevins, MD
Amy K. Evans, MD
Ryan T. Moore, MD
Nicole R. Dobson, MD

Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, Md
Department of Pediatrics, National Naval Medical Center, Bethesda, Md
Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC