A 2-day-old male infant born at 36 weeks to a gravida 3, para 2 woman is transferred to the regional level 4 NICU from a community hospital nursery because of concerns for apneic events, decreased tone, and bilious emesis.
The pregnancy was unremarkable. Prenatal serologies were negative. Group B Streptococcus status was unknown. She was adequately treated with penicillin prophylaxis before the uncomplicated delivery. The infant was born vaginally. Apgar scores at birth were 8 and 9 at 1 and 5 minutes, respectively.
In the nursery, the infant is noted have temperature instability 5 hours after birth. He has 2 episodes of hypoglycemia (37 mg/dL [2.05 mmol/L] at 11 hours after birth, 31 mg/dL [1.72 mmol/L] at 12 hours after birth) and receives dextrose gel twice. At 22 hours after birth, the infant has 2 episodes of bilious emesis. Abdominal radiography is performed, and the patient is given nothing by...
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