Differential Diagnosis for a 6-hour-old Girl with Respiratory Distress
Single most likely diagnosis:
- E. Polycythemia: The patient's symptoms of respiratory distress, tachypnea, and plethoric appearance, combined with a hematocrit of 71% (above the normal range), strongly suggest polycythemia. This condition can lead to increased blood viscosity, which may cause respiratory and other systemic symptoms.
Other Likely diagnoses:
- C. Dehydration: Although the patient's blood pressure is normal, the history of not being able to feed due to tachypnea and the low glucose level (35 mg/dL) could indicate dehydration, which might contribute to the patient's symptoms.
- F. Transient tachypnea of the newborn: This is a common condition in newborns, especially after vaginal delivery, and could be a contributing factor to the patient's respiratory distress.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- B. Cyanotic heart disease: Although the chest x-ray shows a normal cardiac silhouette and pulse oximetry is 96% on room air, cyanotic heart disease can sometimes present with minimal initial findings. It is crucial to consider this diagnosis due to its severe implications.
- A. Congenital adrenal hyperplasia: This condition can cause hypoglycemia (low glucose level), which is present in this patient. Although less likely given the other findings, it is a critical diagnosis not to miss due to its potential for severe consequences if untreated.
Rare diagnoses:
- D. Glycogen storage disease: While this could explain the hypoglycemia, it is less likely given the patient's other symptoms and the fact that glycogen storage diseases are rare. However, it remains a consideration in the differential diagnosis for unexplained hypoglycemia in a newborn.