Review Question - QID 105470

Vaginal spotting or bleeding is normal in female infants less than 3 months of age and will stop as soon as maternal estrogens are cleared from the baby's blood. The parents of this child only require reassurance.

Normal findings in the newborn include non-purulent vaginal discharge, vaginal spotting, and mammary enlargement. All of these symptoms are not a cause for concern and generally regress within a few days. They result from the mother's hormones being transferred to the fetus in utero as well as via breast milk. No workup is required.

Fuloria and Kreiter discuss the newborn examination of the abdomen, pelvis, extremities, genitalia, and spine. The presence of ambiguous genitalia is a medical emergency, and pituitary and adrenal integrity must be established. In contrast, hydroceles are managed conservatively but inguinal hernias may require surgical repair.

In the newborn period, other findings such as neonatal jaundice must be fully evaluated. Moerschel et al. discuss a practical approach to neonatal jaundice. There are severe neurologic sequelae of untreated jaundice in the newborn (kernicterus). Prevention falls into two categories: primary and secondary. In primary prevention, the mother can foster adequate clearance by ensuring proper feeding with 12 feedings per 24 hours. Secondary prevention is achieved by vigilant monitoring and identification of infants at highest risk using both serum and transcutaneous bilirubin measurements and plotting them on a nomogram according to the infant's age in hours.

Illustration A depicts mammary enlargement in the neonate, a normal finding in both males and females.

Incorrect Answers:
Answer 1: A pelvic ultrasound is indicated in the workup of a pelvic mass, but this patient has a benign physical exam with no palpable masses. Furthermore, scant blood at this age is a normal finding and needs no further workup.
Answer 2: A karyotype would be a step in the workup of Turner's syndrome or Down Syndrome, but would not be indicated in this case.
Answers 3 and 5: This patient does not have findings consistent with congenital bilateral adrenal hyperplasia. In a patient with 21-hydroxylase deficiency, one would expect hypotension and hyperkalemia. A patient with 11 beta-hydroxylase deficiency would present with masculinization (ambiguous genitalia) and hypertension which are also not found in this patient.