Pediatric emergency medicine trisk 1454 1454

Necrotizing enterocolitis
Appendicitis
Volvulus
Incarcerated hernia a
Hirschsprung enterocolitis
Neurologic disease
Infant botulism
Shunt obstruction, infection a
Child abuse—intracranial hemorrhage a
a Indicates

more common causes.

TABLE 73.2
MOST COMMON DISORDERS THAT MIMIC SEPSIS
Urinary tract infection
Viremia

Congestive heart failure
Gastroenteritis with dehydration

Pertussis causes coughing, apnea, seizures, and death during infancy. Parents
may report respiratory distress, cough, poor feeding, and vomiting. A careful
history may reveal that the vomiting is often posttussive. History of exposure to
pertussis may be lacking because the infant usually acquires the disease from
older children or adults who have only symptoms of a common upper respiratory
infection. Physical examination will distinguish the infection from sepsis if the
infant has a paroxysmal cough. The characteristic inspiratory “whoop” after a
coughing paroxysm (a hallmark in older patients) is uncommon in very young
infants. Auscultation of the chest is usually normal; tachypnea and cyanosis may
be present. The classic CBC finding of marked lymphocytosis is often absent in

infants with pertussis, and a chest radiograph may not show the typical “shaggy
right heart border” in this age group, though atelectasis or pneumonia may be
present. PCR technique can reliably identify the condition from nasopharyngeal
specimens, and nasopharyngeal culture for Bordetella pertussis is confirmatory.
Infants with congenital syphilis may present in the first 4 weeks of life with
extreme irritability, pallor, jaundice, hepatosplenomegaly, and edema. Pneumonia,
painful limbs, snuffles, and skin lesions are common. Consider this diagnosis if a
history of maternal infection is obtained or if the child has been chronically ill
prior to presentation. Radiographs of the infant’s long bones may reveal diffuse