Aquifer Pediatrics: Case 9 - 2 wk old female with lethargy 2023/2024

Aquifer Pediatrics: Case 9 - 2 wk old female with lethargy Differential Diagnosis for a Neonate with Poor Feeding and Decreased Activity - correct answer Congenital hypothyroidism Shaken Baby Syndrome Down Syndrome Sepsis Congenital Adrenal Hyperplasia Inborn Error of Metabolism Botulism Hypoxic-ischemic encephalopathy Polycythemia Hyperbilirubinemia Congenital Hypothyroidism - correct answer Common findings include: Feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia Shaken baby syndrome - correct answer Risk factors for shaken baby syndrome include: Young/single parents Significant stressors at home (finances, living situation, etc.) Lower education level A history of seizures or irritability would increase the suspicion for this diagnosis. Down syndrome - correct answer Down syndrome patients may feed poorly because of hypotonia. Typically the ROS would be otherwise normal. Sepsis - correct answer Signs of sepsis include poor feeding and decreased activity, among others. Congenital Adrenal Hyperplasia - correct answer Decreased feeding and activity are common in infants with CAH. Salt-losing CAH presents with lethargy, vomiting, and dehydration that can progress to shock. Inborn error of metabolism - correct answer Typically, newborns appear well for at least the first 1-2 days of life but then become symptomatic due to the protein load in breast milk or formula. Initial signs include somnolence and poor feeding, usually followed by vomiting and lethargy. Without treatment, patients develop a progressive encephalopathy. Botulism - correct answer nfants with botulism present with a poor suck and weak cry. This is a rare diagnosis (about 900 cases reported worldwide!) and usually presents a little later (median onset 3-4 months of age). Hypoxic-Ischemic encephalopathy - correct answer Altered mental status can be seen with hypoxic-ischemic encephalopathy, but would typically appear shortly after birth. Infants with this disorder often have low APGAR scores. Often there is evidence of multi-system dysfunction (poor cardiac contractility, perfusion, renal insufficiency, seizures) early in the neonatal course. Polycythemia - correct answer his occurs when the hematocrit is above the normal limit for gestational age (usually defined as > 65% in a term newborn). Many infants are asymptomatic, and hematocrits are not routinely checked in newborns.