Case 1: Electrolyte Abnormalities in 7-day-old Girl

Inna Kaminecki; Thomas Vates; Frank Barrows; Susan Hudome

doi:10.1542/pir.2017-0195

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Inna Kaminecki, MD*
Thomas Vates, MD*
Frank Barrows, DO*
Susan Hudome, MD*

^*Department of Pediatrics, The Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ

AUTHOR DISCLOSURE
Drs Kaminecki, Vates, Barrows, and Hudome have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

EDITOR’S NOTE

While many of our patients are excitedly back in school this month, others are struggling to adjust to educational programs for their special needs, and others are getting used to medication regimens and having access to emergency medications. This month’s Index of Suspicion cases all touch on endocrinology, but they also remind us of our need to adapt school and medication administration to maximize outcomes for all of our patients.

Philip R. Fischer, MD

Associate Editor, Index of Suspicion

Presentation

A newborn girl was admitted to the NICU for prematurity and respiratory distress. The mother's pregnancy had been complicated with gestational diabetes and preeclampsia with severe hypertension. After administering 2 doses of betamethasone to the mother to promote fetal lung maturation before delivery, the infant was delivered vaginally at 34.1 weeks' gestational age after labor induction. The mother, a 49-year-old woman (gravida, 4; para, 2) had a significant obstetric history, including 1 miscarriage, 1 stillbirth, and 1 healthy child with another partner. The current partner and father of this newborn had 1 healthy child from a previous marriage.

The current patient was a product of in vitro fertilization performed outside of the United States with a donor egg and the father's sperm. Preimplantation genetic testing was performed to detect aneuploidy of chromosomes 13, 18, 21, X, and Y. Prenatal care was administered outside of the United States until 27 weeks' gestational age; thereafter, the mother received obstetric care in the United States. Fetal ultrasonography at 34 weeks' gestational age yielded normal results.

At birth, the patient’s weight was 1,790 g. Initially she received respiratory support with nasal continuous positive …