Case 3: Two-week-old Male Infant with Progressive Emesis

Abstract

A 14-day-old term white male infant presents to his primary pediatrician’s office with a 3-day history of progressive emesis, which is described by his mother as nonbloody and nonbilious in nature. The mother reports that emesis is frequently associated with feeding and occasionally projectile in nature, with 8 to 10 episodes in the last 24 hours. It is reported that he is taking 2 ounces of expressed human milk every 2.5 hours. His urine and stool output is adequate. The pregnancy was uncomplicated, but labor was complicated by mild shoulder dystocia. The infant’s birthweight was 3,980 g. His blood type is B negative and direct antiglobulin testing positive, with Apgar scores of 5 and 10 at 1 and 5 minutes, respectively, requiring only tactile stimulation for resuscitation. He was discharged from the hospital 2 days after birth with a portable phototherapy device for jaundice, which was required for 3 days. On examination, his weight is 3,920 g, not back to birthweight. He is afebrile, with otherwise unremarkable vital signs and has mild jaundice without icterus. He demonstrates signs of mild dehydration with sunken anterior fontanelle and mildly delayed capillary refill; the remainder of the examination findings were unremarkable. Based on the patient’s history of voluminous and projectile emesis with inadequate weight gain, pyloric stenosis is the primary concern. Abdominal ultrasonography reveals the diagnosis. Ultrasonography demonstrates a normal pylorus with bilateral …