The Case
Setting: Outpatient pediatric office
On day of life 3, Danyal Babar was brought to the pediatrician’s office for a weight check.
Newborn history:
Danyal was born at 38 weeks via spontaneous vaginal delivery. He is the second child of a married couple who emigrated from Pakistan to Louisville.
Birth weight was 3.8kg (91st percentile), length 48.2cm (25th percentile), and head circumference 33cm (25th percentile).
At 6 hours post birth Danyal was reported to be ‘jittery’ and a capillary heel prick blood test revealed a blood glucose reading of 32 mg/dL.
Breast-feeding was initiated and his capillary blood glucose was monitored over the next 48 hours.
His blood glucose levels stayed above 70, and mother and baby were discharged at 2 days post birth after the standard newborn screen was obtained.
Neonatal follow-up:
Vital signs were normal for age. He was mildly jaundiced over his head and chest.
A transcutaneous bilirubin was 11 mg/dL.
Mom reported continued poor feeding with struggling to latch and only staying on the breast for a few minutes each feed. Her milk has come in and she was pumping the remainder of milk produced. His weight was 3.5 kg, and he was having 4-5 small seedy stools daily. A blood glucose was rechecked and was 77 mg/dL. Mom was advised to continue to offer breast milk feeds on demand and follow up the next day.
