A 32-day-old term girl is brought to the emergency department by her grandparents for ongoing emesis with feeds and weight loss. The patient’s birth history was complicated by limited prenatal care, maternal substance abuse, perinatal hepatitis C exposure, and a 14-day stay in the NICU for thrombocytopenia requiring platelet transfusion, with the eventual diagnosis of May-Hegglin anomaly. At hospital discharge she had a normal platelet count, was tolerating 40 to 90 mL of hydrolyzed formula every 3 hours, and had no issues with voiding or elimination. Weight at the time of discharge (13 days of age) was 2.5% below birthweight.

The patient now presents with frequent projectile, nonbloody, nonbilious emesis within an hour after feeds since discharge. The addition of ranitidine by her pediatrician within days of discharge did not improve her symptoms. Outpatient pyloric ultrasonography was not suggestive of pyloric stenosis. The patient takes approximately 1 oz of hydrolyzed...

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