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NeoReviews Vol.9 No.12 2008 e590
© 2008 American Academy of Pediatrics

Index of Suspicion in the Nursery

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


   Case 1 Presentation
 
After an uncomplicated pregnancy, a term female infant is delivered vaginally to a healthy 29-year-old primigravida whose serology test results are within normal parameters. Apgar scores are 8 and 9 at 1 at 5 minutes, respectively. Shortly after delivery, a "blueberry muffin" rash is noted on the infant. Her initial complete blood count shows a white blood cell (WBC) count of 70.0x103/mcL (70.0x109/L) with 74% blasts on the peripheral smear. The patient is admitted to the neonatal intensive care unit for further evaluation.

Physical examination on admission reveals an infant who is breathing comfortably on room air, has a birthweight of 3,220 g, and exhibits no dysmorphic features. The liver edge is palpable, and a purpuric petechial rash involves the trunk, extremities, face, and lower lip. Multiple 1- to 2-cm palpable purple nodules are nonblanching and nontender, resembling a blueberry muffin. The remainder of the examination findings are unremarkable. Laboratory investigation reveals a repeat elevated WBC count of 70.0x103/mcL (70.0x109/L) with 14% blasts, platelet count of 50x103/mcL (50x109/L), uric acid of 7.8 mg/dL (464.0 mcmol/L), lactate dehydrogenase of 1,974 international units/L (normal, <400 international units/L), prothrombin time of 30 seconds, and International Normalized Ratio (INR) of 2.8. Further laboratory tests aid in the diagnosis.


   Case 2 Presentation
 
A 3-week-old male presents to the pediatrician's office for routine follow-up after discharge from the neonatal intensive care unit. He was born at term via emergent cesarean section for late decelerations and decreased fetal movement. He displayed apnea at birth and was placed on a ventilator for suspected meconium aspiration syndrome. Intravenous antibiotics also were initiated for possible sepsis. On the second postnatal day, the infant demonstrated brief clonic posturing of his upper extremities, which was treated with . . . [Full Text of this Article]

Han Tjoeng, MD, MPH
Tasnim Najaf, MD

Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Mo

Arvind Srinath, MD
Brian Costello, MD
David Cooke, MD

Johns Hopkins University School of Medicine, Baltimore, Md
Emory University School of Medicine, Atlanta, Ga
Johns Hopkins University School of Medicine, Baltimore, Md


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Copyright © 2008 by the American Academy of Pediatrics.