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Home > EB Store > Enterovirus And The Neonate Controversies In The Diagnosis And Management Of Potentially Lethal Infections
Enterovirus And The Neonate Controversies In The Diagnosis And Management Of Potentially Lethal Infections - $30.00
This issue includes 4 AMA/ACEP category 1, AAP Prescribed CME credits
Authors:
Karen Goodman, MD Sylvia Garcia, MD
Audrey Paul, MD, PhD
Peer Reviewer:
Ghazala Q. Sharieff, MD, FACEP, FAAEM, FAAP
Publication Date:
March 1, 2009, Volume 6, Number 3
Excerpt from the issue…
A baby girl with perioral cyanosis and respiratory distress is rushed in from triage. As the baby is hooked up to the monitors and given supplemental oxygen, your nurses try to calm the family while you assess the newborn. As your thoughts run through the different causes of respiratory distress in an infant, you pick up on some of the story that the father is trying to tell. “This has been going on for a few days,” he cries. “No one took us seriously, but I knew that this was more than just a cold!” The mother is sobbing in the background, claiming that now her baby will have to stay in the hospital again. You note that this baby is indeed in distress. The baby’s RR is 70 and her HR is 180 beats per minute. While your nurses obtain IV access on the baby, you order a portable chest x-ray and ask the father, “What has been going on? When was the baby in the hospital?” He takes a deep breath and begins to tell you that his wife had a perfectly normal pregnancy but delivered at 36 weeks. The baby was doing well and was discharged home from the NICU 3 days later. At 4 days of life, the baby began to show signs of congestion and was not feeding well. The mother interjects that her older son was a “better eater” in comparison to her little girl. They took the baby to their local pediatrician, who advised them that the baby had some congestion and taught them how to use a nasal aspirator. They were assured that every baby is different and that their daughter simply may not nurse as well as their son. The following day, they returned to the pediatrician, who suggested that perhaps the mother did not have enough breast milk and that the baby was latching for prolonged periods because she was not satisfied. Again the baby was sent home, and an attempt was made to give some formula. Throughout the night, the baby’s condition worsened. They called the pediatrician’s service and were asked several questions by the nurse on call. The baby was afebrile, had been making urine, and the calculated respiratory rate according to the nurse’s instruction was within the normal range. They were told to follow up with their doctor. By morning, the baby started to develop “weird” breathing while taking the bottle, and her color just did not look right. Frustrated and scared, her parents thought they would bring the baby to the hospital where she was born.
As the father finishes his story, you look at the patient’s chest x-ray and ask the resident to call the pediatric cardiologist on call. You note the enlarged heart and ask for an electrocardiogram (ECG) and echocardiogram (ECHO). You explain to the baby’s father that the baby has cardiomegaly. You know his next question is going to be “from what?” You do not have the answer. You begin to think of all of the possible causes of heart failure, and as you examine the neonate you begin to give some orders. You know that the baby may soon need to be intubated. You begin to discuss the differential with the parents, and as you mention viral myocarditis, the mother begins to shake uncontrollably. The father sees her response and asks “What is that? What causes it? Who could she have gotten that from? When would she have gotten that?” Finally, the mother looks up and says, “I had a really bad cold during the delivery, could she have gotten this from me?” How do you answer? Though you are unsure of the cause, you are also unsure of a favorable prognosis.
About this article: Given the possible severe sequelae of enteroviral infection in neonates, this issue of Pediatric Emergency Medicine Practice explores the controversy taking an evidence-based approach.
