Foregone Inclusion: Neonatal CMV Hepatitis and Cholestasis

Excerpt

A two-month-old boy who had been born at 32-week gestation was initially evaluated by a community urgent care clinic with scleral icterus and mild respiratory distress. The patient’s mother reported that she had noted repeated waking and crying cycles over the previous several weeks. He also had frequent non-projectile “spit-ups” associated with feedings. His neonatal intensive care unit (NICU) course had been remarkable for continuous positive airway pressure (CPAP) for 24 h after birth, total parenteral nutrition for approximately 20 days until he was transitioned to full enteral feeds, and phototherapy for 3 days for total bilirubin levels in the 7–8 mg/dL range. Serial head ultrasounds were notable for a tiny left-sided choroid plexus cyst. Of note, patient had failed his newborn hearing screen and was scheduled for repeat testing. He was discharged home from the NICU at 3 weeks of age. His standard newborn screening panel demonstrated elevated phenylalanine/tyrosine ratio (nonspecific for metabolic disease). Maternal prenatal laboratories were reassuring; furthermore, there was no maternal history of thyroid disorder and there was no indication for CMV testing during pregnancy. …