Clinical Case 3

Leo is a 6-week-old baby, born at term, who is brought in by ambulance in the middle of the night. Mum tells you that she has had a few “terrible days” where he seems hungry all the time but doesn’t spend much time on the breast at each individual feed.
Tonight, she thought he looked a bit blue during one of his feeds. This has now resolved and he looks awake and settled.

On examination, his observations are all within normal limits, he is small for his age, he has dropped a centile on the growth chart for his weight. He has equal, strong femoral pulses, but a loud pansystolic murmur, hepatomegaly and some bibasal creps.

Mum is anxious but is keen to go home.