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NeoReviews Vol.9 No.2 2008 e85
© 2008 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.


   Case Report
 
An 11-day-old infant, who had been delivered at term via cesarean section, presents to the emergency department because of progressive diarrhea, poor feeding, and bilateral periorbital swelling and redness. His history includes eye discharge that developed at 2 days after birth and was treated with tobramycin eye drops. At 5 days of age, he had been brought to his pediatrician because of persistent eye discharge, a temperature of 102.2° (39°C), diarrhea, and poor feeding. A complete blood count at that visit revealed normal values and an elevated C-reactive protein value of 17 mg/L (1.7 mg/dL) (normal ≤12 mg/L [1.2 mg/dL]). He was started on oral rehydration solution and tobramycin/dexamethasone eye drops and given one dose of intramuscular cefuroxime.

On physical examination today, he is afebrile, lethargic, and grunting with a poor cry. He has normal fontanelles, bilateral periorbital swelling and redness, and small violaceous lesions over the upper and lower eyelash lines and eyelids bilaterally (Fig. 1) associated with odorless yellow secretions. He has adequate air entry bilaterally, a soft abdomen, and no hepatosplenomegaly. His skin shows loss of turgor and elasticity but no evidence of petechiae or rash. Neurologic examination reveals poor suck, weak grasp, and incomplete Moro reflex. Results of laboratory studies include: hemoglobin, 15.3 g/dL (153 g/L); white blood cell count, 13.3x103/mL (13.3x109/L), with 53% segmented forms, 25% lymphocytes, and 10% monocytes; platelet count, 125x103/mcL (125x109/L); C-reactive protein, 278 mg/L (27.8 mg/dL); prothrombin time of 28.7 seconds (normal, 11.9 sec); . . . [Full Text of this Article]

Mohamad H. Itani, MB, ChB
Mossaab Hassoun, MD
Mohamad Younis, MD

Rafik Hariri University Hospital, Beirut, Lebanon


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