Well, there has been quite the response to this case. The neonate always brings up quite an emotion. The differential thus far offered includes:
Infection: SBI, RSV/bronchiolitis, HSV, Sepsis
Other: anemia, metabolic disease, congenital heart disease, NAT, periodic breathing
"ALTE" though it's a symptom, not a diagnosis
Workup could be from something to everything.
On a different note, once this long (8 hrs) an observation period has passed (2% of this kid's life), it is always imperative to go back and look for lurking clues the parents and the infant have to offer. Nursing input can also be invaluable as they may have been complicit with the 8 hour stay as they felt something was not right but unable to identify it nor willing to subject the infant to tests. Often, asking the caregivers (nurse, parents, grandparents, etc.) what they are most concerned about can yield surprising results and not only a comforting few words from you but also a direction for the workup.
Looking forward to the denouement soon.
Clicking here will take you to the original Hot Seat Case #2
Infection: SBI, RSV/bronchiolitis, HSV, Sepsis
Other: anemia, metabolic disease, congenital heart disease, NAT, periodic breathing
"ALTE" though it's a symptom, not a diagnosis
Workup could be from something to everything.
On a different note, once this long (8 hrs) an observation period has passed (2% of this kid's life), it is always imperative to go back and look for lurking clues the parents and the infant have to offer. Nursing input can also be invaluable as they may have been complicit with the 8 hour stay as they felt something was not right but unable to identify it nor willing to subject the infant to tests. Often, asking the caregivers (nurse, parents, grandparents, etc.) what they are most concerned about can yield surprising results and not only a comforting few words from you but also a direction for the workup.
Looking forward to the denouement soon.
Clicking here will take you to the original Hot Seat Case #2
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