A 17-month-old male infant had a three-day history of vomiting, trembling, and lethargy. Vomiting occurred five to six times each day and consisted of half of his feedings. No bowel movements were noted for three days before admission.
History disclosed that the patient was the 950-g product of a 26- to 28-week gestation. Delivery was uncomplicated, but severe respiratory distress syndrome necessitated intubation and prolonged oxygen administration and ventilator assistance. This resulted in bronchopulmonary dysplasia, subglottic stenosis that required a tracheostomy, and retrolental fibroplasia with bilateral retinal detachment and blindness. At 7 months of age, a fundoplication and gastrostomy were performed because of severe gastroesophageal reflux. Other problems included arrested hydrocephalus, a questionable seizure disorder, and developmental delay. He was hospitalized for the first ten months of life and, because his mother gave him up, was discharged to a foster home. He required readmission to the hospital several times for