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NeoReviews Vol.9 No.5 2008 e223
© 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
 
One day after a "routine" circumcision, an otherwise healthy 3-day-old term neonate presents with swelling, ecchymosis, and oozing from the circumcision site. There are no petechiae or other bruises. Pregnancy and delivery had been uncomplicated. His vital signs and growth parameters are normal. Results of his neurologic examination are normal, and he has no skeletal abnormalities or dysmorphic features. He is the third of three male children born to a nonconsanguineous couple. The two older brothers had normal perinatal courses, including uncomplicated circumcisions. There is no family history of hemophilia.

Laboratory work reveals a platelet count of 9.0x103/mcL (9.0x109/L), white blood cell count of 15.0x103/mcL (15.0x109/L), hemoglobin of 17.6 g/dL (176 g/L), and hematocrit of 45.8% (0.458). Review of the blood smear shows no platelet clumps. Ultrasonography of the head shows no intraventricular hemorrhage. The mother has no history of immune thrombocytopenia (ITP), and her platelet count is normal. A platelet transfusion is ordered. One hour after the transfusion, a platelet count is 18.0x103/mcL (18.0x109/L). Four hours later, the platelet count is 10.0x103/mcL (10.0x109/L). Further evaluation of the parents yields the diagnosis.


   Case Discussion
 
The differential diagnosis of severe neonatal thrombocytopenia can be categorized broadly into disorders of increased platelet consumption or decreased production (Table). Included in these categories are congenital viral infection, sepsis, perinatal asphyxia, placental . . . [Full Text of this Article]

Amanda Conti, MD
W. Benjamin Rothwell, MD
Satkiran S. Grewal, MD
Matthew W. Richardson, MD

Baystate Children's Hospital, Springfield, Mass






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Copyright © 2008 by the American Academy of Pediatrics.