Index of Suspicion in the NurseryCase 1: Factitious Disorder by Proxy in the NICU: Is That Possible?Case 2: Poor Feeding in a 7-day-old Female

Editor’s Note The case presented here does not conform completely to the usual format for cases in Index of Suspicion in the Nursery but should be of interest to all who manage infants in a NICU .- Alistair G.S. Philip, MD A 32-week-old female infant was born to a 23-year-old gravida 3 mother via cesarean delivery due to placental abruption and breech presentation. Her Apgar scores were 4, 6, and 9 at 1, 5, and 10 minutes, respectively. The infant was transported to the NICU for further management. The parents were of a low socioeconomic status and were not consanguineous. The mother had an erratic and incomplete follow-up during pregnancy. She reported that her firstborn was healthy but that her second child was born with multiple anomalies. The latter infant died at home from unknown causes a few hours after being discharged from our NICU at the age of 19 days. Upon admission to the NICU, the currently reported infant was stable, her birthweight was 1,310 g, and her head circumference was 28 cm (appropriate for gestational age). The results of her physical examination were normal. Her blood laboratory test results on admission were normal, as were results of kidney function tests. Broad-spectrum antibiotics and caffeine treatment were initiated. ### The Diagnosis and Course Schizencephaly was diagnosed during a routine head ultrasound. Nevertheless, the infant was asymptomatic, and the neurologic examination was normal for her age. The parents were informed about the findings and the possible future implications of schizencephaly. At the age of 10 days, a rise in the infant’s body temperature to 37.9°C mandated a full sepsis evaluation. Results of all laboratory tests and cultures were within normal ranges and sterile, respectively. The pathologic results revealed hypernatremia of 174 mmol/L, creatinine of 1.04 mg/dL, and blood urea nitrogen of 23 mg/dL. Because …