Author: Rob Stafford / Editor: Steve Fordham / Reviewer: Thomas MacMahon, Rob Stafford / Codes: A3, CC1, O7 / Published: 30/11/2021
A mother presented to the Emergency Department (ED) with her 4-week-old baby that had been drowsy and was not feeding as usual. She also described that he had been crying less than usual. His nappy had been dry all day and there had been no passage of stool on the day of presentation. He had had one normal pooey nappy yesterday.
The baby had been vomiting after all his feeds for the last 2 weeks. He was described as feeding well, but then vomiting (sometimes projectile) afterwards; direct questioning confirmed that it had never been green coloured. After vomiting he often cried and didnt settle; she said that he seemed hungry all the time and wouldnt settle at night. He has never had a temperature.
This was her first baby. She had an uneventful pregnancy and had a normal vaginal delivery at 41+2 weeks; the baby was 3.81Kg at birth. The baby fed well after delivery and passed meconium in the first 24 hours.
Weight on presentation was 4.02Kg. The baby was asleep in the mothers arms. The following observations were recorded by the nurse:
- Pulse: 180bpm
- Respiratory rate: 28
- Temp: 36.6 degree Celsius
- O2 saturations: 98% on air
- Blood sugar: 4.6
On examination the baby had a sunken anterior fontanelle. The mucous membranes were dry and the babys peripheries were cool. The capillary refill was 4 seconds. There was no rash visible. The heart sounds were normal and the femoral pulses were clearly palpable. There was no increased work of breathing and the chest was clear on auscultation. The abdomen was soft and non-tender. There was no jaundice. The testes are descended and normal on palpation.
