A 1-day-old girl is in the newborn nursery undergoing routine evaluation. She was born at term to a 24-year-old woman by uncomplicated vaginal delivery. The Apgar scores were 7 at 1 minute and 8 at 5 minutes. The prenatal course was complicated with asymptomatic bacteriuria that was treated with an antibiotic. The mother took multivitamins daily throughout the pregnancy. Physical examination of the infant shows bilaterally enlarged mammary glands. The labia are slightly swollen and blood-tinged vaginal discharge is seen. What is the best next step in the management of this patient?

Question

A 1-day-old girl is in the newborn nursery undergoing routine evaluation.  She was born at term to a 24-year-old woman by uncomplicated vaginal delivery.  The Apgar scores were 7 at 1 minute and 8 at 5 minutes.  The prenatal course was complicated with asymptomatic bacteriuria that was treated with an antibiotic.  The mother took multivitamins daily throughout the pregnancy.  Physical examination of the infant shows bilaterally enlarged mammary glands.  The labia are slightly swollen and blood-tinged vaginal discharge is seen.  What is the best next step in the management of this patient?

Quizplus · Accepted Answer

11ec25c8_d66e_9151_bc81_2d8c76002a21_MD0003_00 Mammary gland enlargement, non-purulent vaginal discharge (leukorrhea), and mild uterine withdrawal bleeding are benign transient findings commonly seen in newborns; these are physiologic responses to transplacental maternal estrogen exposure. Work-up is unnecessary. Routine care and reassurance should be provided. (Choice A) A buccal smear was previously used to diagnose Turner syndrome but has now been replaced by karyotyping. (Choices B and E) Imaging of the adrenal glands and urinary corticosteroid precursor measurement are used to diagnose congenital adrenal hyperplasia. Affected girls have masculinized external genitalia (including clitoromegaly). (Choices C and D) Assessment of ovarian ultrasound and FSH and LH levels are useful in patients with premature thelarche presenting after infancy. Educational objective: Mammary gland enlargement, leukorrhea, and mild uterine bleeding are common, benign, and transient in newborns. These are physiologic responses to transplacental maternal estrogen exposure. No work-up is indicated. References: Establishment of normative data for the amount of breast tissue present in healthy children up to two years of age. (http://www.ncbi.nlm.nih.gov/pubmed/20493740) Is premature thelarche in the first two years of life transient? (http://www.ncbi.nlm.nih.gov/pubmed/22985613) Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. (http://www.ncbi.nlm.nih.gov/pubmed/21274291)

A 1-Day-Old Girl Is in the Newborn Nursery Undergoing Routine