Case 1: Newborn with poor feeding and lethargy
P Louie | P Thiessen | RG Rodrigues
Case 2: Why was this developmentally delayed child so irritable?
Newborn with poor feeding
A four-day-old Mennonite infant was sent for admission by
his primary care physician because of decreased feeding and
lethargy. Apparently, he had breastfed normally for the first
two days of life, but early on day 3, he became difficult to
arouse and would only feed for 5 min before falling asleep at
the breast. Attempts to supplement the feeds with formula
were unsuccessful. Delivered at home by a midwife after an
uncomplicated pregnancy and vaginal delivery, the infant
had experienced no fever, vomiting or diarrhea. His birth
weight was 3453 g.
Why was this developmentally
delayed child so irritable?
An eight-year-old girl with a known mitochondrial disorder
(complex 1 deficiency), intractable seizures and severe
developmental delay initially presented with right leg pain.
A complete blood count and erythrocyte sedimentation rate
were reported as normal. X-rays of the lower limbs revealed
osteopenia, and a bone scan showed decreased uptake in the
left ankle. She was seen by an orthopedic surgeon who
attributed her bone scan abnormality to ?arthritis?. She
deteriorated over the next two months, becoming nonweight
bearing and increasingly irritable. This ultimately
resulted in her requiring hospitalization for workup of her