Case 3: Jaundice, Pallor, and Failure to Thrive in a 7-week-old Infant

1. Brigid O’Brien, DO* 2. Brittany Middleton, MD* 3. Erica Cua, MD* 4. Alex Resnick, MD* 5. Cynthia H. Ho, MD*,† 1. Departments of *Pediatrics and 2. †Internal Medicine, University of Southern California Medical Center, Keck School of Medicine, Los Angeles, CA A 7-week-old African-American boy is brought to the hospital by a social worker after law enforcement responded to a report of domestic violence between his parents. History from the social worker is limited. She states that the infant is fussy but has tolerated a bottle of infant formula. On physical examination, his weight is 3.7 kg (<5th percentile), length is 55 cm (25th percentile), and head circumference is 39 cm (25th-50th percentile). Vital signs are: temperature 98.2°F (36.8°C), heart rate 159 beats/min, blood pressure 75/51 mm Hg, and respiratory rate 36 breaths/min. The baby is thin, jaundiced, and pale but is alert and cooing. He appears severely dehydrated, with delayed capillary refill of 3 seconds. There is no rash, petechiae, or organomegaly. Laboratory evaluation shows total bilirubin of 15.2 mg/dL (259.98 μmol/L) and conjugated bilirubin of 0.5 mg/dL (8.55 μmol/L). Complete blood cell count reveals a white blood cell count of 7,600/μL (7.6 x 109/L), hemoglobin of 7.6 g/dL (76 g/L), hematocrit of 22.6% (0.226), platelet count of 251 × 103/μL (251 x 109/L), mean corpuscular volume of 84.7 μm3 (84.7 fL), and red cell distribution width of 18.3%. Urinalysis is negative for blood, leukocyte esterase, nitrites, and reducing substances. Urine and blood cultures are obtained. The newborn screening result is checked and is negative for congenital hypothyroidism but reveals homozygous sickle hemoglobin (Hgb SS) consistent with sickle cell disease (SCD). Additional evaluation leads to the cause of his pallor and jaundice. The infant was hospitalized for failure …