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NeoReviews Vol.9 No.3 2008 e124
© 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
 
A 4-day-old term male infant develops progressive irritability with pallor and poor capillary refill. He has been hospitalized in the intensive care nursery for refractory hypoglycemia since birth. He has no risk factors for hypoglycemia, and his glucose concentrations have stabilized to normal limits with the administration of intravenous 20% glucose through an umbilical venous catheter (UVC). Imaging of the UVC initially showed placement in the liver; the UVC was withdrawn 1 to 15 cm and confirmed by chest radiograph to be in the right atrium.

The infant has been otherwise well, with stable vital signs and unremarkable laboratory values except for glucose. At the onset of irritability, glucose concentrations are normal. He is afebrile, but develops rapidly progressive hypoxia and bradycardia that requires the administration of 100% oxygen. Transillumination of the chest wall does not suggest pneumothorax. A chest radiograph reveals a cardiac silhouette at the upper limit of normal, but well-aerated lung zones without infiltrates (Fig. 1). A complete blood count (CBC) and blood cultures are obtained, and prophylactic ampicillin and gentamicin are initiated. Electrocardiography reveals normal results. Four extremity blood pressures are attempted but are unable to be recorded. The infant deteriorates to asystole, is intubated with an endotracheal tube, and receives cardiopulmonary resuscitation (CPR).


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  		Figure 1. Chest radiograph showing the cardiac silhouette at the upper limit of normal, but no lung infiltrates.

 
During resuscitation, epinephrine is administered via the endotracheal tube, and bicarbonate and fluid repletion are provided. A prostaglandin drip is started. When these interventions do not result in clinical improvement, intravenous epinephrine is administered without response. Within 10 minutes of resuscitation, beside echocardiography is obtained and reveals the diagnosis (Fig. 2).


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  		Figure 2. Echocardiographic image.

 

   Case 2 Presentation
 
A 10-day-old male infant is admitted to the hospital because of abdominal distention. He was delivered at term by repeat cesarean . . . [Full Text of this Article]

Megan Wills Kullnat, MD
Steven N. Weindling, MD
Robert A. Darnall, MD

Pediatric Cardiology
Neonatology, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Dartmouth, NH

S. Hossein Fakhraee, MD, FAAP
M. Kazemian, MD
Sh. Noripour, MD

Division of Neonatology, Mofid Children's Hospital, Tehran, Iran


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Copyright © 2008 by the American Academy of Pediatrics.