A three-week-old boy born full-term, normal spontaneous vaginal delivery without complication is brought in by his father because he received a letter in the mail that he did not understand about some laboratory tests for his son. The father is not sure about the baby’s eating habits, but states that “he’s a crier”, and sometimes vomits before feedings. He is afebrile and his vital signs are normal.  The physical exam is significant for a sleepy newborn with a hyperpigmented scrotum. His weight is 3.7 kg, the same as his birth weight. What is the most appropriate management?

A.   Do a head-to-toe exam looking for causes of “increased crying”, and, if negative and tolerates fluids by mouth, refer to his pediatrician.
B.   Check the baby’s blood glucose, and if normal and eating in the ED, refer to his pediatrician.
C.   After a thorough history and physical, if negative, refer to Failure to Thrive clinic
D.   Draw blood for serum chemistry

In the meantime, a quote --
  "In the presence of the patient, Latin is the language."   -Medieval medical saying


BIG Mike
11/13/2012 11:59am

Answer is D. While hyperpigmented scrotum can be a normal variant in a neonate, in combination with FTT the concern would be for congenital adrenal hyperplasia. The hyperpigmentation in this situation occurs due to stimulation of melanocytes. Regardless if the child can take PO while in the ED, I would check first an accucheck and second electrolytes to ensure the patient is not hyponatremic/hyperkalemic.

11/13/2012 11:59am



Leave a Reply