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NeoReviews Vol.8 No.12 2007 e551
© 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 term male is born via scheduled repeat cesarean section to a 28-year-old G2P1 woman following an uncomplicated pregnancy. Serologic test results were unremarkable, including a negative screen for group B Streptococcus (GBS). The infant cries immediately at birth, and his Apgar scores are 9 at both 1 and 5 minutes. He is rooming-in with his mother. At 16 hours of age, he exhibits perioral cyanosis while attempting to breastfeed. Pulse oximetry measures 85% and, therefore, free-flowing supplemental oxygen is delivered by mask, increasing his pulse oximetry reading to 100%. Gradually, he is weaned to room air. On physical examination, his heart rate is 150 beats/min and his respiratory rate is 60 breaths/min while crying. He has no dysmorphisms, appears well, has a lusty cry, and is vigorous. His capillary refill time is 5 seconds, his peripheral pulses are well felt, and his blood pressure is 80/40 mm Hg in the right arm. Results of a complete blood count (CBC) and differential count are unremarkable. Ampicillin and gentamicin are initiated. A laboratory evaluation reveals the diagnosis.


   Case Discussion
 
     The Diagnosis
A prolonged capillary refill time can be caused hypothermia or shock. The ambient temperature and the infant’s body temperature rule out hypothermia in this case. Hypovolemic shock (hemorrhagic shock) is unlikely because there is no history of . . . [Full Text of this Article]

Akshaya J. Vachharajani

Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo


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Copyright © 2007 by the American Academy of Pediatrics.