A 6-week-old term boy is admitted to the hospital for a 3-week history of growth
failure and diarrhea. At age 36 days, he had been admitted for vomiting and diarrhea,
at which time abdominal ultrasonography was negative for pyloric stenosis
and other abnormalities. An upper gastrointestinal (GI) series showed GI reflux to
the thoracic inlet, but findings were otherwise normal. Blood, stool, and urine culture
results were negative. He continued on exclusive breastfeeding, gained weight,
and was discharged with the diagnosis of GI reflux and an antireflux medication.
Now, he is readmitted for increased diarrhea, decreased interest in feedings, and
weight loss.
Physical examination reveals a small, wasted infant who is alert and has a weight of
3.3 kg (<3rd 53="" and="" circumference="" cm="" head="" length="" of="" p="" percentile="" th="">of 39 cm (50th percentile). No dysmorphic features are evident, but facial and temporal
wasting and a large, soft, flat fontanelle are present. His abdomen is scaphoid
without organomegaly, and his extremities show decreased subcutaneous fat and
loose skin. He has no abnormal pulmonary or cardiovascular findings. Despite suspension
of oral feedings, the baby continues to pass more than 6 loose, watery stools
daily. Repeated viral and bacterial stool cultures are negative. Additional evaluation
reveals the diagnosis.
failure and diarrhea. At age 36 days, he had been admitted for vomiting and diarrhea,
at which time abdominal ultrasonography was negative for pyloric stenosis
and other abnormalities. An upper gastrointestinal (GI) series showed GI reflux to
the thoracic inlet, but findings were otherwise normal. Blood, stool, and urine culture
results were negative. He continued on exclusive breastfeeding, gained weight,
and was discharged with the diagnosis of GI reflux and an antireflux medication.
Now, he is readmitted for increased diarrhea, decreased interest in feedings, and
weight loss.
Physical examination reveals a small, wasted infant who is alert and has a weight of
3.3 kg (<3rd 53="" and="" circumference="" cm="" head="" length="" of="" p="" percentile="" th="">of 39 cm (50th percentile). No dysmorphic features are evident, but facial and temporal
wasting and a large, soft, flat fontanelle are present. His abdomen is scaphoid
without organomegaly, and his extremities show decreased subcutaneous fat and
loose skin. He has no abnormal pulmonary or cardiovascular findings. Despite suspension
of oral feedings, the baby continues to pass more than 6 loose, watery stools
daily. Repeated viral and bacterial stool cultures are negative. Additional evaluation
reveals the diagnosis.
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