Self-assessment

Abstract

Sophie is a 36 hour old baby who presented to the Paediatric Assessment Unit yesterday with 9% weight loss and poor feeding. Antenatal scans suggested Sophie was small for gestational age but she weighed 3.6 kg at birth and is the largest baby when compared to mother's four previous children. Pregnancy was otherwise uneventful and mother did not receive a glucose tolerance test. She was born by normal vaginal delivery in hospital at full term and discharged home 6 hours later; her mother noted that she struggled to take the bottle for feeds prior to discharge home. There are no risk factors for sepsis. Family history is unremarkable apart from Type 1 Diabetes Mellitus in the father and several of his family members. On examination, Sophie has a soft fontanelle, normal cardiovascular, respiratory and abdominal examinations. Both femoral pulses are palpable. She is not dysmorphic. Blood gas is normal except the blood sugar, which is 2.0 mmol/litre. A feed is immediately given by nasogastric tube as Sophie will not take the bottle. The feed is an appropriate volume based on 90 ml/kg/day every 3 hours. A blood sugar is repeated 1 hour after this feed and is found to be 1.4.