Digestive system/gastrointestinal (other)
Inpatient hospital

The patient is an ex-35 week premature infant who presented to the emergency department with fever, vomiting, diarrhea, and decreased oral intake. She was well until a few days prior to her presentation when she developed cold symptoms including vomiting, diarrhea, and decreased oral intake. She developed a fever up to 102 F and also had decreased urine output. She was given acetaminophen, and her fever went down to 101 F. She had not been able to eat or drink anything that day. She then had an accidental collision with her cousin where they banged their heads together. She had a change in behavior after that including babbling frequently and rolling her head. This prompted her mother to call for emergency services.

The health plan's determination is overturned. The inpatient stay was medically necessary. This is an infant who presented with fever, vomiting, diarrhea, and decreased oral intake. She also had a closed head injury. Her urine sample findings were consistent with urinary tract infection, and she had fever and tachycardia at the time of presentation. Inpatient care for urinary tract infection is needed for children with vomiting or inability to tolerate oral medication. She required inpatient admission for the administration of intravenous antibiotics to treat her infection and intravenous fluids to maintain her hydration status, along with close monitoring with additional therapies as needed.
The decision making at the time of admission for this patient was consistent with her very young age, the presence of fever, vomiting and decreased oral intake in the setting of a presumed urinary tract infection, and the need for parenteral therapies and intravenous fluids with close monitoring for potential deterioration of clinical status.