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NeoReviews Vol.9 No.7 2008 e310
© 2008 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 40-day-old female infant is admitted to the hospital following 10 days of fever, poor feeding, and irritability. She has had no vomiting, diarrhea, or symptoms of an upper respiratory tract infection. The infant had been born at term following a pregnancy that was complicated by maternal low-grade fever and arthralgia in the latter part of the gestation. The infant's Apgar scores were 8 and 9 at 1 and 5 minutes, respectively, and her birthweight was 2.8 kg. She had no immediate postnatal problems and received routine neonatal immunization, including hepatitis B, bacille Calmette-Guérin (BCG), and oral polio vaccines, according to national policy. She has been breastfed since birth.

The patient has had fever since 15 days of age for which she was hospitalized in another hospital and received ampicillin and amikacin for possible sepsis and pneumonia, based on the presence of ill-defined pulmonary infiltrates on chest radiography. She was discharged from the hospital at about 1 month of age after becoming afebrile for a couple of days. A few days later, the baby again developed fever, irritability, and poor feeding that lasted up to the day of this admission.

Physical examination today reveals a febrile, irritable, pale-looking infant whose weight is 3.5 kg, length is 51 cm, head circumference is 35 cm, axillary temperature is 104°F (40°C), pulse rate is 116 beats/min, and respiratory rate is 30 breaths/min. Laboratory studies reveal:

Serum calcium, electrolytes, blood glucose, blood urea nitrogen, and serum creatinine values all are normal. Urinalysis shows 2+ proteinuria. Cerebrospinal fluid (CSF) . . . [Full Text of this Article]

S. Hossein Fakhraee, MD, FAAP
Mohammad Kazemian, MD

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






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