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what am I missing? Edematous newborn

Term newborn, no complications, non traumatic vag
delivery - noted to have bilat lower extrem edema
right after birth - pitting that moved all the way up
to her thighs and hips.  Edema around eyes too.  Exam
otherwise normal - no ambiguous genitalia.  Urine
output improved over the first day to >2 cc/kg/hr.
Formula fed.  U/A normal.  CMP pretty normal - total
prot and albumin slightly low with only exception of
Na 132.  Na remained at 132 for the next couple days.
I saw pt on call for first time on DOL 3 - good wt
loss, good u/o but continued BLE edema and
hyponatremia.  Restricted her formula intake to 80
cc/kg/d for a day and Na improved to 132 --> 137 -->
142.  BUN up to 10 that came down after her feeds were
liberalized again.  Edema was significantly improved
at discharge yesterday.  I can't find a unifying
explanation for this....  Any ideas?

Eve H Switzer, MD, FAAP


		
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