Case Study: Newborn with Vomiting and Diarrhea

Updated | Published
by SafetyNurse1968 SafetyNurse1968, ADN, BSN, MSN, PhD

Specializes in Oncology, Home Health, Patient Safety. Has 20 years experience.

A three-day old male infant is brought to the ER by his 22-yr-old mother with vomiting and diarrhea. Diagnostic results will be released upon request, with the final reveal in one week.

Can you figure out what's wrong with this little guy?

Case Study: Newborn with Vomiting and Diarrhea

Chief Complaint

A three-day old male infant is brought to the ER with vomiting and diarrhea by his 22-yr-old white mother. The mother states, “It started yesterday. He sleeps all the time, but when he’s awake he just won’t stop crying and I can’t get him to stop throwing up after he eats.” This is the mother’s first pregnancy. The infant was full term and there were no complications during the vaginal birth. A full assessment is performed, and the infant is admitted to the hospital.

Assessment Findings

  • Depressed fontanels
  • High-pitched cry lasting more than 5 minutes.
  • Moro reflex is hyperactive.
  • Mild tremors when disturbed.
  • Increased muscle tone, no excoriation of chin, knees, elbows, toes or nose, myoclonic jerks present. Yawns frequently. No nasal stuffiness, nasal flaring or sneezing apparent.
  • Skin is dry with no mottling. 

Vital Signs

  • BP 89/60 RA, lying
  • HR 110 bpm
  • RR 70/min with no retractions
  • T 101o F
  • O2 sat 98%
  • Weight at birth 5 lbs 6 ounces
  • Current weight: 5 lbs 4 ounces

What’s going on here? What other information do you need? What labs do you want? What other diagnostic tests should we run?

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is also a mother of four who loves to write so much that she would probably starve if her phone didn’t remind her to take a break. Her work experiences as a hospital nurse make it easy to skip using the bathroom to get in just a few more minutes on the computer. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com. You can also get free Continuing Education at www.safetyfirstnursing.com.

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23 Comment(s)

UrbanHealthRN, BSN, RN

Specializes in Community and Public Health, Addictions Nursing. Has 12 years experience. 231 Posts

Oooh a pedi case! 

I'm thinking infectious disease vs. congenital disorder. I'd need labs from both mom and baby to help determine that. For mom, I'd double check her immunology labs, especially Group B Strep. For baby, I would want a septic work-up and the results of the Newborn Screening Panel. 

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 16 years experience. 14,297 Posts

I responded at the help desk. I don't want to say what I think or what I would do, because I'm afraid I will give it away. But I can tell you I'm pretty sure I knew immediately what it is, based on infant's presentation. I would just need to interview the mom for confirmation.

SafetyNurse1968, ADN, BSN, MSN, PhD

Specializes in Oncology, Home Health, Patient Safety. Has 20 years experience. 81 Articles; 522 Posts

6 minutes ago, klone said:

I responded at the help desk. I don't want to say what I think or what I would do, because I'm afraid I will give it away. But I can tell you I'm pretty sure I knew immediately what it is, based on infant's presentation. I would just need to interview the mom for confirmation.

You’re on the right track- more info coming soon!

chare

3,577 Posts

Maternal History

  • Prenatal care?
  • Maternal past medical history
  • Maternal substance use (recreational and medicinal)?
  • Maternal serology (GBS, HSV, immunology, serology)?

Infant History & Assessment Findings

  • How frequent is the diarrhea?
  • How, how frequently, and what is the infant being fed?
  • Relationship of vomiting and feeding?
  • Back arching or rigidity?
  • How many diapers per day?
  • Skin assessment findings (color, lesions)

Additional Labs & Diagnostics

  • Point of care glucose
  • Basic metabolic panel (including bilirubin)
  • Complete blood count
  • Coombs
  • Four extremity blood pressures
  • Meconium toxicology screen

Consider (Depending Upon Maternal and Prenatal History)

  • Abdominal radiograph
  • Abdominal ultrasound
  • Cranial ultrasound
  • Blood culture
  • Lumbar puncture

SafetyNurse1968, ADN, BSN, MSN, PhD

Specializes in Oncology, Home Health, Patient Safety. Has 20 years experience. 81 Articles; 522 Posts

15 minutes ago, chare said:

Maternal History

  • Prenatal care?
  • Maternal past medical history
  • Maternal substance use (recreational and medicinal)?
  • Maternal serology (GBS, HSV, immunology, serology)?

Infant History & Assessment Findings

  • How frequent is the diarrhea?
  • How, how frequently, and what is the infant being fed?
  • Relationship of vomiting and feeding?
  • Back arching or rigidity?
  • How many diapers per day?
  • Skin assessment findings (color, lesions)

Additional Labs & Diagnostics

  • Point of care glucose
  • Basic metabolic panel (including bilirubin)
  • Complete blood count
  • Coombs
  • Four extremity blood pressures
  • Meconium toxicology screen

Consider (Depending Upon Maternal and Prenatal History)

  • Abdominal radiograph
  • Abdominal ultrasound
  • Cranial ultrasound
  • Blood culture
  • Lumbar puncture

Excellent questions! More data coming soon!

EDNURSE20

EDNURSE20, BSN

Specializes in ED, med-surg, peri op. Has 5 years experience. 451 Posts

This one has lost me. Most babies I see with D+Vs have some sort of viral infection and are dehydrated. But I don’t think this is the case. 

this is frustrating  

i3mn

i3mn, BSN

13 Posts

I am not clear how to post an answer to the Admin help desk. Do I open a new topic? 

sirI, MSN, APRN, NP

Specializes in Education, FP, LNC, Forensics, ED, OB. 18 Articles; 13,669 Posts

7 hours ago, i3mn said:

I am not clear how to post an answer to the Admin help desk. Do I open a new topic? 

Hello @i3mn,

Yes, just click ADMIN HELP DESK and ADD NEW TOPIC.

spotangel, DNP, RN, NP

Specializes in ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds. Has 33 years experience. 45 Articles; 516 Posts

9 hours ago, sirI said:

Hello @i3mn,

Yes, just click ADMIN HELP DESK and ADD NEW TOPIC.

Not working for me!

 Tried PM.

That did not work either------ not sure what else to do!