Case published: December 2025
Case submitted by: Morgan Beebe
Pediatric Nephrology Faculty Reviewer: John Mahan

History of Present Illness (HPI)

A 4-week baby boy born at 23 weeks to a 36-year-old G2P2 via emergency C-section for bleeding and pre-term labor is transferred from an outside hospital for higher level of care after undergoing exploratory laparotomy and bowel resection with ostomy creation for necrotizing enterocolitis (NEC) with hypotension and abnormal labs.

He is admitted to the intensive care unit and initiated on vasopressor support, intubated on an oscillator, and sedated. A large patent ductus arteriosus (PDA) is found on echocardiogram. He is receiving dextrose-containing intravenous fluids and has not received enteral feeds or parenteral nutrition for over 72 hours. His urine output has downtrended and the urine draining in Foley catheter appears blood-tinged. Nephrology is consulted for rising serum creatinine and potassium.

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