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NeoReviews Vol.10 No.5 2009 e245
© 2009 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 300 words of the full text of this article appear below.


   Case Presentation
 
An 11-day-old female presents to her primary care physician's office with a 1-day history of decreased oral intake and reduced energy. Today she developed increased work of breathing at home. On physical examination, the infant exhibits hypothermia, and the physician refers her to the emergency department where her rectal temperature is measured at 94.9°F (35.0°C). The parents deny any ill contacts, and review of systems is negative for rhinorrhea, coughing, vomiting, and diarrhea.

In the emergency department, a complete blood count and blood and urine cultures are obtained. While in the process of undergoing a lumbar puncture, the infant has an acute episode of apnea and bradycardia that does not resolve with stimulation. She receives chest compressions and a dose of atropine and is endotracheally intubated. Shortly thereafter, she has an episode of "eye rolling" that appears to be "seizure-like." Head computed tomography (CT) scan is read as normal. On returning from the CT scanner, she develops duskiness with poor perfusion and weak peripheral pulses. Blood pressure is unmeasurable. Dopamine, ampicillin, and gentamicin are administered, and the infant is transferred to a tertiary care institution.

The infant was born at 38 weeks’ gestation via cesarean section due to a previous cesarean delivery to a 36-year-old G2P1 woman who is blood type O+ and had negative serologies. The mother had prenatal care, and the pregnancy was complicated by maternal hypothyroidism treated with levothyroxine. The mother denies any acute illnesses or viral symptoms during pregnancy or labor. Labor occurred for 26 hours and membranes were ruptured at the time of the cesarean section. After delivery, the infant received blow-by oxygen briefly; Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. She was discharged from the hospital general care nursery 4 days after birth when her mother recovered from her . . . [Full Text of this Article]

Kelly W. West, MD
Stanford T. Shulman, MD
Sandra B. Cadichon, MD

Children's Memorial Hospital, Chicago, Ill


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