A 12-Day-Old Female with Hypothermia, Hypoglycemia and Hyperbilirubinemia

Area of Science:

• Neonatal Medicine
• Pediatric Endocrinology
• Gastroenterology

Background:

• A small-for-gestational-age neonate presented with concerning symptoms.
• The infant exhibited worsening hyperbilirubinemia, hypoglycemia, and hypothermia over one week.

Purpose of the Study:

• To investigate the underlying causes of severe hyperbilirubinemia, hypoglycemia, and hypothermia in a neonate.
• To describe the diagnostic workup and management of a complex neonatal case.

Main Methods:

• Clinical presentation and emergency department evaluation.
• Intensive care unit (ICU) admission with supportive care including intravenous glucose, bowel rest, and phototherapy.
• Laboratory investigations including thyroid-stimulating hormone, thyroxine, cortisol, and growth hormone levels.

Main Results:

• Transaminitis, pneumatosis intestinalis, indirect hyperbilirubinemia, and hypoglycemia were identified.
• Low thyroid hormone and cortisol levels, with undetectable growth hormone, suggested multiple endocrine deficiencies.
• The infant responded to supportive care and was hospitalized for 19 days.

Conclusions:

• The case highlights the importance of considering endocrine dysfunction in neonates presenting with severe hyperbilirubinemia, hypoglycemia, and hypothermia.
• Multisystemic involvement necessitates a comprehensive diagnostic approach and tailored management strategies.
• Early recognition and intervention are crucial for favorable outcomes in critically ill neonates.