Case 2: Newborn with Seizures, Renal Failure, and Weight Loss

Abstract

A 5-day-old male infant born at 37 weeks’ gestation to a gravida 1, para 1 mother is transferred to the PICU of an academic medical center for concerns of weight loss, electrolyte derangement, and seizure activity. Prenatal laboratory results are unremarkable, with the exception of Chlamydia infection that is treated in the first trimester and group B Streptococcus infection that is adequately treated during delivery. The infant’s Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. His birthweight is 2,722 g (3rd percentile), his length is 46 cm (3rd percentile), and his head circumference is 32 cm (3rd percentile). He receives formula in the newborn nursery and is noted to have frequent episodes of emesis, prompting a change in formula type before discharge. He has 1 meconium stool and several wet diapers. He is discharged 2 days after birth with a weight of 2,580 g (3rd percentile). He is seen by his pediatrician 4 days after birth and now weighs 2,126 g, 22% lower than his birthweight. He again is noted to have frequent episodes of emesis. The pediatrician refers him for admission to a local hospital for failure to thrive. Admission laboratory findings include: glucose, 105 mg/dL (5.8 mmol/L); sodium, 148 mEq/L (148 mmol/L); potassium, 7.1 mEq/L (7.1 mmol/L); chloride, 70 mEq/L (70 mmol/L), bicarbonate, 41 mEq/L (41 mmol/L); blood urea nitrogen, 100 mg/dL (35.7 mmol/L); creatinine, 4 …