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NeoReviews Vol.9 No.10 2008 e483
© 2008 American Academy of Pediatrics

Index of Suspicion in the Nursery

Abbreviations: CNS: central nervous system • CSF: cerebrospinal fluid • HSV: herpes simplex virus • SEM: skin, eyes, and mouth • SIADH: syndrome of inappropriate secretion of antidiuretic hormone

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


   Case 1 Presentation
 
A female neonate born at 38 weeks’ gestation presents to the emergency department on the eighth day after birth with a 2-day history of seizures. Two days ago, she began to have episodes of rightward eye deviation and shaking and stiffness of the right arm and leg. According to her parents, the episodes always occur while the neonate is awake, and she cries just prior to them. The spells typically last less than 15 seconds and are followed by heavy sleeping. Other than these spells, the neonate is acting normally and feeding appropriately, has remained afebrile, and her parents note no other complaints.

The infant was born via a normal, spontaneous vaginal delivery to a 27-year-old multiparous woman. The pregnancy was complicated by diabetes mellitus, requiring glyburide therapy. Maternal screening test results included O-negative blood type; rubella-immune; and negative screening for syphilis, hepatitis B surface antigen, and group B streptococcal culture. The mother denies any history of herpes simplex viral infection. The neonate's delivery occurred less than 12 hours after rupture of membranes and meconium was present, but the infant was vigorous and required only routine resuscitation. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. The neonate's hospital stay was unremarkable, and she was discharged on the second day after birth.

On evaluation in the emergency department, the infant weighs 3,550 g (50th percentile) and has a temperature of 99.1°F (37.2°C), heart rate of 130 beats/min, respiratory rate of 40 breaths/min, and oxygen saturation of 98%. Physical examination reveals a normal-appearing neonate who has no evidence of trauma and exhibits appropriate behavior and activity. Head examination shows normal findings, with open and flat fontanelles and normal retinal examination findings. Results of the cardiovascular, pulmonary, and abdominal examinations are normal. The neurologic examination reveals no abnormal movements, . . . [Full Text of this Article]

Andrew Doyle, MD
Theresa Heifert, MD

Winn Army Community Hospital, Fort Stewart, Ga

Hassan Ibrahim, MD
Dalibor Kurepa, MD
Sameh Hussein, MD
Barbara Bruner, NNP
Hillary Tice, PharmD
Catrell McCulloch, MD

Louisiana University Health Science Center, Shreveport, La






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