Aquifer Pediatrics 01 Case Study – Newborn Male Infant Evaluation and Care
This case relates to a 20-year-old G1P0 female who reported to the inpatient obstetrics service in the 38th week of pregnancy in active labor. Her pregnancy status was defined as tobacco and alcohol use during pregnancy and low maternal weight gain during pregnancy. She delivered a term appropriate for gestational age, small for gestational age, and normocephalic male neonate. Yet, no clinical signs and symptoms suggestive of SGA status were noted in the physical examination. Other relevant laboratory investigations were also within normal range. Per current clinical practice protocols, this essay analyzes and describes the diagnosis, differential diagnosis, diagnostic approach, and management plan for this newborn.
Main Diagnosis: SGA Newborn
There is evidence of asymmetrical IUGR in the newborn due to a fetal weight of less than the 10th percentile for the gestational age. This occurs in 8-10% of pregnancies and results in increased neonatal morbidity and mortality (Sacchi et al., 2020). It is evidenced based on the SGA and the mother’s history of exposure to teratogens, including alcohol and tobacco. Prenatal care deficit has assessed maternal history as a challenge. The infant’s weight and length were below the 10th percentile, but the head size was normal, so the condition is asymmetrical IUGR.
Differential Diagnoses
Fetal Alcohol Syndrome (FAS)
FAS is a possible differential diagnosis because the mother mentioned drinking alcohol during pregnancy. Some features associated with FAS include growth delay, abnormal face structure, and CNS impairment (Vorgias & Bernstein, 2021). Nonetheless, clinical assessment failed to elicit the FAS indicators, which include a smooth philtrum, thin upper lip, and small eye fissure. Second, there are no reports of severe abnormalities of the CNS during the first examination, which makes FAS unlikely.
Congenital Infections (TORCHZ)
Another differential diagnosis to be considered is congenital infection, including the TORCHZ complex, which is Toxoplasmosis, and other infections, Rubella, Cytomegalovirus, Herpes simplex, and Zika virus, as indicated by Lynn et al. (2023). They may cause IUGR and other neonatal complications. Thus, the absence of clinical signs like hepatosplenomegaly, jaundice, petechiae, or microcephaly decreases the suspicion of congenital infection in this instance.
Diagnostic Plan
To reconfirm the diagnosis in cases of SGA due to poor maternal nutrition and tobacco use, several recommended diagnostic tests exist. First, a comprehensive ultrasound examination should be performed to evaluate fetal growth characteristics, amount of the amniotic fluid, and placental condition. Besides, ultrasonography can help identify the type of IUGR, whether symmetrical or asymmetrical and determine if there is any structural abnormality (Chew & Verma, 2022). Second, umbilical artery Doppler studies can help understand blood flow and the function of the placenta, an essential parameter in IUGR management. Lastly, simple blood tests, such as CBC and metabolic panel, can be performed to evaluate the general state of a newborn. Detecting other infections, such as syphilis and HIV, that have a potential impact on fetal growth should not be excluded if deemed necessary.
Treatment, Education, and Follow-Up
For the initial treatment, it is necessary to properly feed the newborn, regularly assess its growth parameters, and respond to any pathologies.
Nutritional Support
First, it is important to provide sufficient energy intake in the form of calories for SGA infants to facilitate catch-up growth (Kosmeri et al., 2023). The newborn should be breastfed, and if it is necessary to supplement the baby, then only formula feeding should be allowed. Monitoring weight change is important to assess the effectiveness of nutritional interventions.
Monitoring and Follow-Up
Next, to ensure appropriate growth and development as well as any other issues, the infant should be seen by a pediatrician for follow-up. Such visits are important so as to detect any complications and treat them in their initial stages.
Parental Education
Also, it is important to educate the mother on the necessity of observing proper nutrition in the future to avoid any complications with the newborn or any future pregnancies, as Alamneh et al. (2020) note. For smoking, there should be advice to stop smoking, and no alcohol should be allowed, and for treatment, there should be group support or therapy.
Hospitalization and Consultations
If the newborn shows serious issues or challenges, such as weight loss or failure to feed well, among others, then the baby must be admitted. Consulting with other professionals, including neonatologists and nutritionists, may be useful in getting further tips on how to handle an SGA infant.
Immunizations and Routine Care
As highlighted by Oktaria et al. (2022), infants must be regularly taken for immunization and newborn care. This entails administering preventive care when needed, such as Vitamin K injections, Hepatitis B vaccine, and Hearing and Metabolic tests.
References
Alamneh, A. A., Endris, B. S., & Gebreyesus, S. H. (2020). Caffeine, alcohol, khat, and tobacco use during pregnancy in Butajira, South Central Ethiopia. PLOS ONE, 15(5), e0232712. https://doi.org/10.1371/journal.pone.0232712
Chew, L. C., & Verma, R. P. (2022). Fetal growth restriction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562268/
Kosmeri, C., Giapros, V., Rallis, D., Balomenou, F., Serbis, A., & Baltogianni, M. (2023). Classification and special nutritional needs of SGA infants and neonates of multiple pregnancies. Nutrients, 15(12), 2736. https://doi.org/10.3390/nu15122736
Lynn, M. K., Aquino, M. S. R., Self, S. C. W., Kanyangarara, M., Campbell, B. A., & Nolan, M. S. (2023). TORCH Congenital Syndrome Infections in Central America’s Northern Triangle. Microorganisms, 11(2), 257. https://doi.org/10.3390/microorganisms11020257
Oktaria, V., Bines, J. E., Murni, I. K., Dinari, R., Indraswari, B. W., Alvianita, A., Putri, D. A., & Danchin, M. (2022). Timeliness of routine childhood vaccinations in Indonesian infants in the first year of life. Vaccine, 40(21), 2925–2932. https://doi.org/10.1016/j.vaccine.2022.04.001
Sacchi, C., Marino, C., Nosarti, C., Vieno, A., Visentin, S., & Simonelli, A. (2020). Association of intrauterine growth restriction and small for gestational age status with childhood cognitive outcomes. JAMA Pediatrics, 174(8). https://doi.org/10.1001/jamapediatrics.2020.1097
Vorgias, D., & Bernstein, B. (2021). Fetal alcohol syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448178/#:~:text=Fetal%20alcohol%20syndrome%20(FAS)%
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Question 
One to three pages of scholarly writing in paragraph format, not counting the title page or reference page
• Brief introduction of the case
• Identification of the main diagnosis with supporting rationale
• Identification of at least two additional differential diagnoses with a brief rationale for why these were ruled out
• Diagnostic plan with supporting rationale or references
• A specific treatment plan supported by recent clinical guidelines
Aquifer Pediatrics 01 Case Study – Newborn Male Infant Evaluation and Care
Please refer to the rubric for point value and requirements. In general, these elements must be covered as per the rubric:
• PLEASE USE CLINICAL GUIDELINES FOR REFERENCES IN APA FORMAT WITHIN THE LAST 5 YEARS.
• PLEASE SEE ATTACHED OUTLINE TO CREATE AN ESSAY
Summary:
A 20-year-old G1P0 female with no prenatal care is admitted to the inpatient obstetrics service at 38 weeks gestation in active labor. Her pregnancy was complicated by tobacco and alcohol use and poor maternal weight gain. She delivers a term, SGA, normocephalic male newborn. Physical exam and laboratory evaluation for SGA status are unremarkable. The case reviews teratogens; definition and causes of SGA/IUGR; prenatal screening; neonatal GBS risk factors and prophylaxis; congenital infections (TORCHZ); initial steps in newborn resuscitation; APGAR scores; Ballard gestational age assessment; primitive reflexes; routine newborn medical care and discharge instructions. The infant is discharged with his mother after 2 days with instructions to follow up with his pediatrician.
Just Choose two Differential Diagnosis:
Differential Diagnosis (SGA newborn): maternal tobacco use; poor maternal nutrition; fetal alcohol syndrome; chromosomal abnormalities; prematurity (date discrepancy); congenital infection
Final Diagnosis: SGA newborn due to poor maternal nutrition and tobacco use
(Fetal growth abnormalities)