Yes, this is best case ever, mini podcast series, and I'm your host, Dr. Anton Hellman.

On this month's best case ever, we have with us Dr. Anthony Croco, the chief of ED at McMaster Children's, and the head of division of pediatric

emergency medicine at McMaster University. Dr. Crocko, welcome to EM cases. Thank you very much,

Anton. It's great to be here. And let it rip. Let's hear your best case ever. All right. So I'm a

pediatrician by training, and I have to say, even for me, newborns make me really nervous. And it's not so much newborns with fever that make me nervous, because it's pretty straight up what we do with newborns with fever. You pretty much do everything. You do blood urine, LP, start antibiotics, admit them. It's kind of cookbook medicine. I'll tell you,

the newborns that make me really nervous are the newborns that come in with very vague symptoms.

And so my best case ever was a five-day-old that presented with the presenting complaint as

being a lazy feeder. Now, I have to tell you, in my world, we don't really worry about lazy as a diagnosis because

lazy is a personality trait. And so for someone to be lazy, they have to be a little bit older

than five days of age. And really, when someone says that their child or infant is a lazy

feeder, what they're saying is that their child has an altered level of consciousness.

And this is the absolute nightmare differential

in pediatric emergency medicine. So it's kind of like the weak and dizzy geriatric patient

where there could be pretty much anything wrong with them. 100%. So for me, I know walking in the

door, if this patient has an altered LOC or is a little bit kind of quote unquote lazy with their feeds,

everything is on the differential. Things like appendicitis, which I've seen in a two-day-old,

sepsis, meningitis, encephalitis, viral infections, abuse, metabolic diseases. I mean, the list

goes on and on. And potentially the workup may cost thousands and thousands of dollars,

take days and days and days and involve a lot of painful invasive procedures for the child.

So let me tell you a little bit about what happened in this case. I always start off with a

history and physical exam as we all do. And I can tell you, one of the questions that I always ask

for patients that are in that age population is whether they are fed breastfed or they are bottle fed. And in this case,

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