,Challenging Cases in
Neonatology
CASES FROM NEOREVIEWS
INDEX OF SUSPICION IN THE NURSERY
EDITORS
DARA BRODSKY, MD, FAAP
JOSEF NEU, MD, FAAP
, American Academy of Pediatrics Publishing Staff
Mark Grimes, Vice President, Publishing
Peter Lynch, Senior Manager, Digital Strategy and Product Development
Evonne Acevedo, Editor, Digital Publishing
Theresa Wiener, Production Manager, Clinical and Professional Publications
Amanda Helmholz, Medical Copy Editor
Peg Mulcahy, Manager, Art Direction and Production
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing
Linda Smessaert, Senior Marketing Manager, Professional Resources
Published by the American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143
Telephone: 847/434-4000
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians,
pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety,
and well-being of infants, children, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
The American Academy of Pediatrics is not responsible for the content of the resources mentioned in
this publication. Web site addresses are as current as possible but may change at any time.
Products are mentioned for informational purposes only. Inclusion in this publication does not
imply endorsement by the American Academy of Pediatrics.
Brand names are furnished for identification purposes only. No endorsement of the manufacturers
or products mentioned is implied.
This publication has been developed by the American Academy of Pediatrics. The authors, editors,
and contributors are expert authorities in the field of pediatrics. No commercial involvement of any
kind has been solicited or accepted in the development of the content of this publication.
Every effort is made to keep Challenging Cases in Neonatology consistent with the most
recent advice and information available from the American Academy of Pediatrics.
Special discounts are available for bulk purchases of this publication. E-mail our
Special Sales Department at for more information.
© 2018 American Academy of Pediatrics
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic, mechanical, photocopying, recording,
or otherwise—without prior permission from the publisher (locate title at http://ebooks.aappublications.
org and click on © Get Permissions; you may also fax the permissions editor at 847/434-8780 or
e-mail ). First edition published 2018.
Printed in the United States of America
9-395 1 2 3 4 5 6 7 8 9 10
MA0855
ISBN: 978-1-61002-140-1
eBook: 978-1-61002-141-8
Library of Congress Control Number: 2017940292
, Contents
PREFACE...................................................................................................................................... vii
Part 1. Cardiology
Case 1: Inconsolable Crying While Feeding.................................................................. 3
Case 2: Newborn With Inaudible Heart Sounds.......................................................... 9
Case 3: Noisy Breathing Since Birth.............................................................................. 15
Case 4: Fetal Bradycardia That Persists Postnatally................................................... 21
Part 2. Dermatology
Case 5: Skin Rash, Poor Feeding, and Diarrhea in a 22-Day-Old Boy................... 27
Case 6: A Rash After Intensive Phototherapy............................................................. 35
Case 7: Three-Week-Old With Fever and a Desquamating Rash............................ 41
Case 8: Newborn With Hemorrhagic Papulonodular Lesions................................ 49
Case 9: Term Neonate With Hypotension and Rash................................................. 57
Case 10: Large Skin Defect of the Trunk Noted at Birth............................................. 61
Case 11: An Infant Who Develops an Erythematous Lesion on the Cheek............ 69
Case 12: Seizure-like Symptoms in a 2-Day-Old Term Girl....................................... 77
Part 3. Endocrinology
Case 13: Five-Day-Old With Recurrent Hypoglycemia............................................... 87
Case 14: 5-Week-Old Dehydrated Infant With Increased Urine Output................ 95
Case 15: Premature Baby Girl With Ambiguous Genitalia.......................................101
Case 16: Hypoglycemia in a Term Appropriate for Gestational Age Infant..........111
Case 17: Six-Day-Old With Tachycardia and Tachypnea.........................................117
Part 4. Fluids and Electrolytes
Case 18: Hypernatremia in a 2-Week-Old Preterm Infant.......................................125
Part 5. Gastroenterology
Case 19: Poor Feeding and Emesis in a 1-Day-Old Boy............................................131
Case 20: A Preterm Newborn Who Has Abdominal Ascites...................................141
Case 21: A Preterm Girl Who Has a Distended Abdomen and
Absent Bowel Sounds.......................................................................................149
Case 22: Late Preterm Infant With an Abdominal Mass..........................................155
Case 23: Coagulopathy, Hepatomegaly, and Ascites in a Term Newborn.............161
iii
Neonatology
CASES FROM NEOREVIEWS
INDEX OF SUSPICION IN THE NURSERY
EDITORS
DARA BRODSKY, MD, FAAP
JOSEF NEU, MD, FAAP
, American Academy of Pediatrics Publishing Staff
Mark Grimes, Vice President, Publishing
Peter Lynch, Senior Manager, Digital Strategy and Product Development
Evonne Acevedo, Editor, Digital Publishing
Theresa Wiener, Production Manager, Clinical and Professional Publications
Amanda Helmholz, Medical Copy Editor
Peg Mulcahy, Manager, Art Direction and Production
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing
Linda Smessaert, Senior Marketing Manager, Professional Resources
Published by the American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143
Telephone: 847/434-4000
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians,
pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety,
and well-being of infants, children, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
The American Academy of Pediatrics is not responsible for the content of the resources mentioned in
this publication. Web site addresses are as current as possible but may change at any time.
Products are mentioned for informational purposes only. Inclusion in this publication does not
imply endorsement by the American Academy of Pediatrics.
Brand names are furnished for identification purposes only. No endorsement of the manufacturers
or products mentioned is implied.
This publication has been developed by the American Academy of Pediatrics. The authors, editors,
and contributors are expert authorities in the field of pediatrics. No commercial involvement of any
kind has been solicited or accepted in the development of the content of this publication.
Every effort is made to keep Challenging Cases in Neonatology consistent with the most
recent advice and information available from the American Academy of Pediatrics.
Special discounts are available for bulk purchases of this publication. E-mail our
Special Sales Department at for more information.
© 2018 American Academy of Pediatrics
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic, mechanical, photocopying, recording,
or otherwise—without prior permission from the publisher (locate title at http://ebooks.aappublications.
org and click on © Get Permissions; you may also fax the permissions editor at 847/434-8780 or
e-mail ). First edition published 2018.
Printed in the United States of America
9-395 1 2 3 4 5 6 7 8 9 10
MA0855
ISBN: 978-1-61002-140-1
eBook: 978-1-61002-141-8
Library of Congress Control Number: 2017940292
, Contents
PREFACE...................................................................................................................................... vii
Part 1. Cardiology
Case 1: Inconsolable Crying While Feeding.................................................................. 3
Case 2: Newborn With Inaudible Heart Sounds.......................................................... 9
Case 3: Noisy Breathing Since Birth.............................................................................. 15
Case 4: Fetal Bradycardia That Persists Postnatally................................................... 21
Part 2. Dermatology
Case 5: Skin Rash, Poor Feeding, and Diarrhea in a 22-Day-Old Boy................... 27
Case 6: A Rash After Intensive Phototherapy............................................................. 35
Case 7: Three-Week-Old With Fever and a Desquamating Rash............................ 41
Case 8: Newborn With Hemorrhagic Papulonodular Lesions................................ 49
Case 9: Term Neonate With Hypotension and Rash................................................. 57
Case 10: Large Skin Defect of the Trunk Noted at Birth............................................. 61
Case 11: An Infant Who Develops an Erythematous Lesion on the Cheek............ 69
Case 12: Seizure-like Symptoms in a 2-Day-Old Term Girl....................................... 77
Part 3. Endocrinology
Case 13: Five-Day-Old With Recurrent Hypoglycemia............................................... 87
Case 14: 5-Week-Old Dehydrated Infant With Increased Urine Output................ 95
Case 15: Premature Baby Girl With Ambiguous Genitalia.......................................101
Case 16: Hypoglycemia in a Term Appropriate for Gestational Age Infant..........111
Case 17: Six-Day-Old With Tachycardia and Tachypnea.........................................117
Part 4. Fluids and Electrolytes
Case 18: Hypernatremia in a 2-Week-Old Preterm Infant.......................................125
Part 5. Gastroenterology
Case 19: Poor Feeding and Emesis in a 1-Day-Old Boy............................................131
Case 20: A Preterm Newborn Who Has Abdominal Ascites...................................141
Case 21: A Preterm Girl Who Has a Distended Abdomen and
Absent Bowel Sounds.......................................................................................149
Case 22: Late Preterm Infant With an Abdominal Mass..........................................155
Case 23: Coagulopathy, Hepatomegaly, and Ascites in a Term Newborn.............161
iii
