A 6-week-old premature infant who was born at 29 weeks of gestation present
ed to the emergency department with a several-hour history of stiffness and
increased alarms on his apnea monitor at home. On arrival he was noted to
have generalized seizures, apnea, and bradycardia. He was intubated and req
uired cardiopulmonary resuscitation including chest compressions and medica
tions. After stabilization he was transferred to the neonatal intensive car
e unit for further management. His initial laboratory tests revealed a seru
m calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum pho
sphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first
week of admission, the infant's mother reported that she had administered
a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him.
The infant was discharged after 12 days of hospitalization.
Anticipatory guidance on the stool patterns and behavior of infants can pre
vent misconceptions about constipation that are especially prevalent in new
parents. Proper management of constipation, should it arise, should be add
ressed with all parents at early well-child visits to avoid hazardous compl
ications of treatments.