Infant diagnosis?

Jolie, BSN · Mar 27, 2004

I'm an LPN in a family practice. We have a 2 mo old baby boy pt who has some disturbing (to me) physical attributes. The baby is currently 8 lbs 3 oz, losing weight due to reflux. Never eats more than 1 and a half ounces at a time. He just has no meat on him at all. The physical stuff that bothers me is that the baby's face appears "pinched" and his features are very small. I also notice an occasional sternal retraction when he breathes, no retractions between the ribs that I;ve seen. It just doesn't seem normal. Does any of this ring a bell for any of y'all? Thanks! I keep worrying about him. I'm just afraid something else might be wrong other than the reflux.

Was he a term infant? What was his birth weight? Is his growth symmetrical (weight, length and head circumference all in the same percentile), or are his measurements out of proportion with each other? Is he breast or bottle fed? Are his parents knowledgable about his feeding and nutrition needs? What is the pattern and appearance of his stools? Has he been tested for lactose intolerance? Has he been tried on alternative formulas such as Lacto-free or Nutramigen? Was his reflux documented by a pH study, or is it just assumed that he is refluxing due to poor weight gain? Has he suffered apnea or respiratory infections due to reflux? How is the reflux being treated? Has pyloric stenosis been ruled out? Does SC do an expanded newborn screening for metabolic disorders at birth? If not, would the docs consider sending one to a private lab? Has he had any lab work done such as blood chemistries, CBC or urine metabolic screening? It sounds like he needs a thorough physical, some lab work, and perhaps a pediatric consult to sort this out.

SouthernLPN2RN, MSN, RN, APRN, NP · Mar 27, 2004

He was term, 6lbs someodd ounces. I'm not aware of any formula changes and SC doesn't do anything but a basic newborn screen. I just hope and pray my instinct is wrong. I don't think the doc is worried about it so maybe I'm over reacting.

bergren · Mar 28, 2004

Sounds like it is possibly pyloric stenosis to me - he should have a surgical consult stat. If ruled out, then send to a Gastroenterologist.

Pyloric stenosis is the narrowing of the pylorus due to the hypertrophied pyloric muscle blocking the outlet of the stomach to the the small intestines. Infants with pyloric stenosis begin to vomit during the second to third week of life and evolves into forceful projectile vomiting. Most of the kids I have seen are 4 weeks - 7 weeks by the time it is diagnosed and surgery performed. The vomiting occurs after feeding. The biggest worry is dehydration and electolyte imbalance. How many wet diapers does he have a day? Is the fontanel sunken?

Get back to us with final diagnosis

I'm an LPN in a family practice. We have a 2 mo old baby boy pt who has some disturbing (to me) physical attributes. The baby is currently 8 lbs 3 oz, losing weight due to reflux. Never eats more than 1 and a half ounces at a time. He just has no meat on him at all. The physical stuff that bothers me is that the baby's face appears "pinched" and his features are very small. I also notice an occasional sternal retraction when he breathes, no retractions between the ribs that I;ve seen. It just doesn't seem normal. Does any of this ring a bell for any of y'all? Thanks! I keep worrying about him. I'm just afraid something else might be wrong other than the reflux.

SouthernLPN2RN, MSN, RN, APRN, NP · Mar 28, 2004

Sounds like it is possibly pyloric stenosis to me - he should have a surgical consult stat. If ruled out, then send to a Gastroenterologist.
Pyloric stenosis is the narrowing of the pylorus due to the hypertrophied pyloric muscle blocking the outlet of the stomach to the the small intestines. Infants with pyloric stenosis begin to vomit during the second to third week of life and evolves into forceful projectile vomiting. Most of the kids I have seen are 4 weeks - 7 weeks by the time it is diagnosed and surgery performed. The vomiting occurs after feeding. The biggest worry is dehydration and electolyte imbalance. How many wet diapers does he have a day? Is the fontanel sunken?
Get back to us with final diagnosis

It'll probably be a few weeks before I find anything out. The baby was started on meds for reflux and I pray it helps. I had to give him his shots and I felt soooo bad for him. Thanks for the reply!

bergren · Mar 28, 2004

Tell your doctor you asked a "friend" who is a pediatric nurse and remind him about Pyloric Stenosis. If that is what it is, the drugs will not help. This is a fairly common problem. Any pediatrician can diagnose it - you palpate for the "grape" the knot of muscle at the area of hypertrophy.

SouthernLPN2RN, MSN, RN, APRN, NP · Mar 28, 2004

Tell your doctor you asked a "friend" who is a pediatric nurse and remind him about Pyloric Stenosis. If that is what it is, the drugs will not help. This is a fairly common problem. Any pediatrician can diagnose it - you palpate for the "grape" the knot of muscle at the area of hypertrophy.

Thanks so much! The baby should have a one week f/u and I'll mention it then.

SouthernLPN2RN, MSN, RN, APRN, NP · Apr 3, 2004

The baby came back for his f/u yesterday. Over the weekend he had been dx'd with RSV. The meds are working, no more vomiting, but still not eating well. His cry is so pitiful! Nowhere near as loud as it should be. He also turns blue when he cries. I'm kind of leaning towards CF and so is the doc. He admitted the baby with FTT and ordered a sweat chloride. Hopefully we'll know more on monday.