An Unsuspected Case of Child Physical Abuse in a Pediatric Patient Enrolled in Hospice
Title
An Unsuspected Case of Child Physical Abuse in a Pediatric Patient Enrolled in Hospice
Creator
Harris KW; Ibach MG; Lowen DE; Hills T; Copenhaver EA
Identifier
Publisher
Clinical Pediatrics
Date
2022
Subject
Child; Humans; Hospices; Physical Abuse; Hospice Care; Child Abuse/diagnosis; Palliative Care
Description
Case Report
A 4-month-old infant with a past medical history of complex congenital heart disease and other life-limiting anomalies had been enrolled in hospice at the time of discharge from the neonatal intensive care unit at 5 weeks of age. Past medical history was significant for congenital heart disease analogous to Tetralogy of Fallot status post pulmonary valvuloplasty, blindness, pelvic kidney, ventriculomegaly, hypothyroidism, dysphagia requiring nasal-gastric tube feedings, and 2 chromosomal abnormalities. Medications included propranolol, levothyroxine, and acetaminophen. The patient presented with 4 days of bilateral arm edema and discoloration along with increased fussiness. The patient had multiple prior presentations at other facilities for similar symptoms in bilateral lower extremities, which had been suggested to be a result of the patient’s congestive heart failure and peripheral acrocyanosis. The patient had previously received an empiric course of furosemide with no improvement in symptoms. Review of systems was positive for vomiting after feeds. Family history was significant for an older brother with developmental delay and autism spectrum disorder.
Physical examination showed an alert, fussy infant with coarse facial features and a nasal-gastric tube in place, systolic 4/6 murmur, normal pulmonary examination, increased tone, bilateral upper extremity edema, and lower extremity discoloration, along with tenderness and skin tightness of all extremities. Laboratory work-up was significant for alkaline phosphatase 904 U/L, albumin 3.5 g/dL, d-dimer 3.013 µg/mL, brain natriuretic peptide 66 pg/mL, thyroid-stimulating hormone 16.17 mIU/L, and C-reactive protein 47.1 mg/L. The initial differential diagnosis included, but was not limited to, congestive heart failure, peripheral acrocyanosis, cellulitis, deep vein thrombus, hypothyroidism, and general progression of patient’s rare genetic disorder.
A 4-month-old infant with a past medical history of complex congenital heart disease and other life-limiting anomalies had been enrolled in hospice at the time of discharge from the neonatal intensive care unit at 5 weeks of age. Past medical history was significant for congenital heart disease analogous to Tetralogy of Fallot status post pulmonary valvuloplasty, blindness, pelvic kidney, ventriculomegaly, hypothyroidism, dysphagia requiring nasal-gastric tube feedings, and 2 chromosomal abnormalities. Medications included propranolol, levothyroxine, and acetaminophen. The patient presented with 4 days of bilateral arm edema and discoloration along with increased fussiness. The patient had multiple prior presentations at other facilities for similar symptoms in bilateral lower extremities, which had been suggested to be a result of the patient’s congestive heart failure and peripheral acrocyanosis. The patient had previously received an empiric course of furosemide with no improvement in symptoms. Review of systems was positive for vomiting after feeds. Family history was significant for an older brother with developmental delay and autism spectrum disorder.
Physical examination showed an alert, fussy infant with coarse facial features and a nasal-gastric tube in place, systolic 4/6 murmur, normal pulmonary examination, increased tone, bilateral upper extremity edema, and lower extremity discoloration, along with tenderness and skin tightness of all extremities. Laboratory work-up was significant for alkaline phosphatase 904 U/L, albumin 3.5 g/dL, d-dimer 3.013 µg/mL, brain natriuretic peptide 66 pg/mL, thyroid-stimulating hormone 16.17 mIU/L, and C-reactive protein 47.1 mg/L. The initial differential diagnosis included, but was not limited to, congestive heart failure, peripheral acrocyanosis, cellulitis, deep vein thrombus, hypothyroidism, and general progression of patient’s rare genetic disorder.
Rights
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Citation List Month
February List 2023
URL Address
Collection
Citation
Harris KW; Ibach MG; Lowen DE; Hills T; Copenhaver EA, “An Unsuspected Case of Child Physical Abuse in a Pediatric Patient Enrolled in Hospice,” Pediatric Palliative Care Library, accessed April 29, 2024, https://pedpalascnetlibrary.omeka.net/items/show/18609.