Author Question: Disease for Infant

My good friend, Candace Calvert, drops by today with a medical question. Even though she is a former ER nurse extraordinaire– pediatrics was not her specialty so she is doing what medical people do best– consult an expert and I am happy to help out with the help of one of my physicians.

Candace writes inspirational romance with a medical backdrop. I happily endorsed, Rescue Team, releasing May 1st which is book #2 in the Grace Medical Series. Hope you’ll check out all of her books. She is one talented lady.

Candace Asks:

I need a disease/disorder for a 6 month old baby that would require hospitalization and is hereditary.

Jordyn Says:

Okay, first I have to confess that I got the answer to this question from a physician co-worker who is an encyclopedia for crazy medical conditions. If your child is that zebra in the forest, she will figure out what it is so thanks Cathy for this answer.

A perfect condition would be a Fatty Acid Oxidative Disorder. In this case, a long chain mixed fatty acid oxidase deficiency. Now, before your eyes glaze over with that– I could never write that— checked out look like I may have had in high school algebra you could simply say the child had an inherited metabolic disorder.

The child would appear to be normal and all body symptoms normally functioning until something happens to cause the child to fast such as stomach flu (gastroenteritis) that would cause the child to stop eating due to vomiting.

This definition comes from the follow link:

Definition: Fatty acid oxidation disorders are inherited conditions that affect the way a person’s body breaks down certain fats (fatty acids). A person with a fatty acid oxidation disorder cannot breakdown their stored fat for energy. Consequently, the body begins to fail once food the person has eaten runs out. In addition, fatty acids build up in the blood. In the case of fatty acid oxidation disorders, the inability to break down fats for energy and the build up of fatty acids can cause serious health problems.

In a normal, functioning body, when you no longer are taking in food, your body starts to metabolize muscle and fat for energy. This is actually the basis of some diets that cut out carbs in order to get you to burn fat. It puts your body in a state of “ketosis” which isn’t necessarily an awesome thing– but I digress.

When the body is burning muscle and fat for energy, you get a build-up of ketones in the blood. We can actually see the body is burning ketones by performing a urinalysis that shows ketones.

In this case, what would actually point the physician to think about this particular metabolic disorder is the absence of ketones in a state where the patient would normally be ketotic. For instance, the blood sugar would be dangerously low (10-20– where you could actually seize.) Normal blood sugar is 60-100. When the blood sugar is low, the body should naturally go to protein (muscle) and fat for energy because it is very self serving in wanting to stay alive. On the urinalysis, there would be absence of ketones showing the body’s inability to breakdown these tissues.

Treatment would include infusing a high sugar solution (like D10).

Management of Infant Crying

This week, I’m highlighting some blog posts that I did for Erin MacPherson’s Christian Mama’s Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor’s visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you’ll keep an eye out for them.

There is nothing that will bring a weary family into the ER faster than an infant who won’t stop crying. This is a leading cause of ER visits for the infant population.

Our approach starts with a good physical exam looking for a source of something that would cause the infant pain. Is there an ear infection? Is there a hair tourniquet?  Did they accidentally scratch their eye? Are they dry and fed?

A hair tourniquet happens when a piece of hair becomes wrapped around a baby’s fingers, toes or penis in the case of boys. They are usually easy to identify because the area distal to the constriction becomes purple from lack of blood flow. Imagine when you wrap a string too tightly around the tip of your finger.

If a hair tourniquet is found and we can see the piece of hair, first we’ll try to unwrap it. If it isn’t embedded into the skin, we may try a hair removal product to disintegrate it. If the hair is deeply embedded, the child may require surgical removal.

A corneal abrasion is a scratch to the eyeball and is quite painful. To look for these in a child, we’ll stain their eyeball with a dye and look at it with a Wood’s lamp in a darkened room. If one is present, generally the child is sent home with an antibiotic ointment for the eye for several days.
If a source of the infant’s pain cannot be found, we’ll generally try soothing measures like oral pain medication to see if that will calm the infant.

If the child continues to cry, a source of infection cannot be found and the baby is also resistant to soothing measures, then the physician may choose to proceed with a spinal tap and additional septic work-up. One reason for an inconsolable infant is meningitis.

If a septic work-up is negative, the infant may be said to have colic.

Were you aware of other sources for pain in the infant like a hair tourniquet or corneal abrasion?

Treatment of the Newborn with Fever

I’m highlighting some blog posts this week that I did for Erin MacPherson’s Christian Mama’s Guide last year. Some of you may not know but I am a real live pediatric ER RN. As always, these posts are meant to be educational and do not replace a doctor’s visit if your child is ill.

Erin has a WICKED sense of humor and is releasing a series of books this spring so I hope you’ll keep an eye out for them.

Question:  Is it really a bad idea to take a newborn out in public? What will really happen if he/she gets sick?

Jordyn Says:
I can remember when my youngest was born and was just a few days old when my in-laws came by to visit. My father-in-law was horribly ill with bronchitis, coughing and hacking at the doorway. I held the baby up for them to see from a distance and kindly asked them to go on their way. They could come back around when he was well.
Here’s the issue: An infant less than two months (some doctors will say three months) that presents with a fever of 100.4 or greater generally gets a septic work-up. The concern is that an infant’s immune system hasn’t quite revved up yet and it can become easily overwhelmed by infection. Therefore, we approach this age infant very cautiously to prevent this from happening.
A septic work-up entails gathering specimens from the most likely places that would become infected. This includes placing an IV to get blood for a blood culture and blood counts, doing a urine cath (placing a small plastic tube into the bladder) for urine and doing a spinal tap (lumbar puncture) to collect cerebrospinal fluid (CSF) which is the fluid that bathes the brain.
Infants are generally admitted into the hospital for 24-48 hours at a minimum on IV antibiotics until their cultures are negative. If their cultures are positive, then they would stay longer to get a full course of antibiotics.
This is not always done but is your “worst case scenario” for ER management. There are some situations that may alter the physician’s medical approach. One may be that we can prove the infant has another source for the fever like an ear infection or RSV (in fall and winter). We generally look for these first. If another source cannot be found, then generally, these other tests are performed.
Unfortunately, a small percentage of infants do die from sepsis. This is why we are very cautious. 
As you can see, these are very invasive procedures and this is why I personally encourage minimal public contact when the infant is under two months.
If you choose to take your new baby in public, here are a few guidelines:
1. Use good hand washing. Before anyone touches the baby, they should wash their hands with soap and water. If water is unavailable, then use antiseptic hand gel.
2. If you develop a cold (runny nose, cough) wear a medical mask around the infant. These can be picked up at stores that have a pharmacy.
3. Keep sick siblings away from the newborn.
4. Encourage younger siblings to kiss the baby’s feet or the back of their head.
5. Immunize.
6. Well newborns need to stay out of the ER! A common scenario is for the whole family to show up with a sick older sibling and bring the new baby. This should only happen if that’s your only option. Otherwise, keep the newborn at home with a responsible adult. There isn’t a way to fully decontaminate the ER waiting room. It’s likely the baby will pick something up during the ER visit of the other sibling.