Astrid Sarvis MD, Children’s National Medical Center

The Case
10 day old full term M presenting for scalp swelling that mom noticed while breastfeeding today. Infant born via via c-section due to FTP. Denies instrumentation or other birth trauma. Mom reports the baby is always in her care and denies any trauma at home. No other swelling or bruising noticed by mom. Pt is otherwise acting normally. Breastfeeds 15-20 min every 2 hours. Making 6-8 wet diapers daily. Stooling several times a day, yellow- greenish in color. Mom reports the patient visited the pediatrician soon after birth and there were no concerns at that time.

ROS: As per HPI.
PMH: GBS and STI negative. Remainder as per HPI.
PSH: Circumcision- well healed without excessive bleeding.
FH: No family history of hematologic disorders.

PE:
VS: T 37.1 (rectal) HR 135 RR 36 BP not obtained Sat 98% on RA
The patient is well developed, well nourished and vigorous. Head exam shows a 3x 3 cm boggy R occipital swelling, seems to cross suture lines, with no appreciable bony depression or tenderness. AFSOF. Mild facial jaundice and scleral icterus, no petechiae, bruising or suspicious lesions. His cardiac, pulmonary, and abdominal exams are unrevealing.

An initial attempt to contact the PCP is unsuccessful.

Questions for you:

You send labs, including a CBC, CMP with fractionated bilirubin, coags, LDH, haptoglobin, DAT, and a type and screen. All are within normal range except for:

Total bili 12.8, direct bili 0.3
LDH 455
Haptoglobin < 15

The patient continues to look well.

More Questions:

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