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A neonate with abdominal distension and failure to thrive
  1. Elisa Tadiotto1,
  2. Evelina Maines2,
  3. Daniela Degani1,
  4. Claudia Banzato1,
  5. Rita Balter1,
  6. Giorgia Gugelmo3,
  7. Andrea Dardis4,
  8. Giuseppe Giordano5,
  9. Andrea Bordugo6
  1. 1Pediatric Clinic, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
  2. 2Inherited Metabolic Diseases Unit, Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  3. 3Inherited Metabolic Diseases Unit, Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  4. 4Regional Coordinator Centre for Rare Diseases, University Hospital “Santa Maria della Misericordia”, Udine, Italy
  5. 5Head of Mass Spectrometry Lab, Women's and Children's Health Department, University of Padua, Institute for Pediatric Research (IRP), Padua, Italy
  6. 6Inherited Metabolic Diseases Unit, Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  1. Correspondence to Dr Evelina Maines, Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Piazzale Ludovico Antonio Scuro, 10, Verona 37134, Italy; evelina.maines{at}gmail.com

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A full-term male was born after a pregnancy complicated between 22 and 31 weeks of gestation by non-immune hydrops fetalis (NIH). At 48 h of life, the physical examination revealed jaundice, which was treated successfully with conventional phototherapy for 24 h, and mild hepatomegaly, which was not promptly investigated.

At 20 days of life, the patient presented with a clinical picture of failure to thrive and significant abdominal distension (figure 1). Liver and spleen were palpable at 7 and 8 cm below the costal margin, respectively. The patient was dystrophic without dysmorphic features or signs of neurological involvement. Liver enzyme levels and cholestasis indices were significantly altered (aspartate aminotransferase 126 U/L gamma glutamyl transferase 283 U/L, alkaline phosphatase 533 U/L, total bilirubin 58 mmol/L, conjugated bilirubin 41 mmol/L), while leucocyte count, haemoglobin level, coagulation parameters, albumin and serum glucose level were …

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