Misdiagnosis of Total Parental Nutrition-Related Riboflavin Deficiency: Three Case Reports of Diagnostic Error.

Total parental nutrition (TPN) is a critical component of neonatal intensive care. Supply shortages leading to deficiencies in TPN constituents can have devastating consequences for critically ill patients in the neonatal intensive care unit (NICU), who may be initially misdiagnosed as potential inborn errors of metabolism. Here, we present three cases of patients with prolonged TPN dependence due to intra-abdominal pathology who presented with signs and symptoms concerning for metabolic disorders and who were ultimately determined to be a result of vitamin deficiencies in the TPN after unnecessary testing and interventions had occurred. These diagnostic errors highlight the need for clinicians to maintain a high index of suspicion for nutritional deficiencies when treating patients in the NICU with potential metabolic disorders during times when TPN constituents are not available, as well as advocating to ensure that adequate supplies are maintained for this vulnerable population.

Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.

OBJECTIVE: To determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. STUDY DESIGN: We conducted a retrospective cohort study of 600 consecutive inborn admissions. A physician used the "Safer Dx NICU Instrument" to review the electronic health record for the first 7 days of admission, and categorized cases as "yes," "unclear," or "no" for diagnostic error. A secondary reviewer evaluated all "yes" charts plus a random sample of charts in the other categories. Subsequently, all secondary reviewers reviewed records with discordance between primary and secondary review to arrive at consensus. RESULTS: We identified 37 diagnostic errors (6.2% of study patients) with "substantial agreement" between reviewers (κ = 0.66). The most common diagnostic process breakdown was missed maternal history (51%). CONCLUSION: The frequency of diagnostic error in inborn NICU patients during the first 7 days of admission is 6.2%.

Diagnostic Errors in the Neonatal Intensive Care Unit: A Case Series.

Diagnostic errors remain understudied in neonatal intensive care units (NICUs). The few available studies are primarily autopsy-based, and do not evaluate diagnostic errors that did not result in the patient's death. This case series presents 10 examples of nonlethal diagnostic errors in the NICU-classified according to the component of the diagnostic process which led to the error. These cases demonstrate the presence of diagnostic error in the NICU and highlight the need for further research on this important topic.