Limpness and Pallor in a 26-day-old Girl

Talin Nora Arslanian; Myriam Almeida-Jones; Sarah Myrlee Gustafson

doi:10.1542/pir.2019-0061

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Talin Nora Arslanian, MD*
Myriam Almeida-Jones, MD†
Sarah Myrlee Gustafson, MD*,‡

^*Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA
^†Department of Pediatric Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA
^‡Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA

Address correspondence to: Talin N. Arslanian, MD, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, 757 Westwood Plaza Box 951752, Los Angeles, CA 90095-1752. Email: tarslanian{at}mednet.ucla.edu

AUTHOR DISCLOSURE
Drs Arslanian, Almeida-Jones, and Gustafson 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.

Presentation

A 26-day-old girl who was born at 39 weeks and 4 days’ gestational age via normal spontaneous vaginal delivery is brought in by ambulance for an episode of limpness and pallor. Her mother reports that she had been doing well until the morning of presentation when she became irritable during a diaper change, then became pale and limp. The episode was brief and had resolved by the time of paramedic arrival. This has not happened before. There are no other symptoms, no changes in feeding patterns, and review of systems is unremarkable. Prenatal, perinatal, postnatal courses are reviewed and noted to be uncomplicated, though there is no record of a prenatal anatomy ultrasound.

Her temperature is 97.9^oF (36.6^oC), respirations are 36 breaths/min, heart rate is 160 beats/min, blood pressure is 88/63 mmHg, and oxygen saturation is 100% on room air. Physical exam reveals normal facies, regular rate and rhythm, a 2/6 holosystolic murmur at the left sternal border, and 2+ femoral pulses without brachio-femoral delay. There are also 5 well-circumscribed hypopigmented patches of varying sizes located on the chest, arm, abdomen, leg, and buttocks; the largest patch measures 2 cm by 1 cm. Labs show a white blood cell count of 8.7×10³/mcL (8.7×10⁹/L), hemoglobin of 15.2 g/dL, and platelets of 396 ×10³/mcL (396×10⁹/L). A chemistry panel reveals no electrolyte abnormalities; glucose is 103 g/dL, and total bilirubin …