Hi all.
I admitted two interesting cases today and just wanted to share.

5 day old exclusively bf infant, lost 11 oz since birth, VERY yellow,
actually almost orange. Dry lips and sunken fontanelle but vigorous. Only 2
mec stools since birth, 2 wet diapers per day. No risk factors for infection,
otherwise normal physical exam. Mom with with unbelievable headaches since DC
at 36 hours. Taking nacotic pain meds without much relief but sleeping thru
feeds. Unsure of how often infant is actually eating. In office this mom is
really out of it, obviously in pain, scary... Total Bili = 27.8 (Direct 1.8),
a new personal record. Other labs unremarkable except for evidence of
dehydration. Discussed case with 2 neonatologists. #1 wanted to do exchange
transfusion ASAP. (didn't like that answer) #2 wanted to IV hydrate and start
triple phototherapy (2 overheads plus wallaby). Of course, I went with #2.
Baby continues to look great, bili down to 22 in 8 hours (now everyone
relaxing) and is continuing to bf. The "older" peds can't believe I didn't
stop bf. Some say I'm getting very "gutsy."
Mom getting CT tonight. Hopefully we can figure this out quickly.

Also admitted an 8 mo old with vomiting/diarrhea/dehyration/fever. Turns out
it is Salmonella in her stools and blood culture. Older brother has lizards
and iquanas at home. Remember, its not just turtles but all reptiles. The AAP
states no reptiles in home with kids under 5yrs. Actual cases of Salmonella
menigitis reported. Beware.

Karen Stepan, DO, FAAP, IBCLC
Mountain View Pediatrics
Flagstaff, AZ