After many years of trying to get pregnant again, Kenneth and Vicki Johnson were thrilled at the birth of their baby Nicole. Their first child had died mysteriously at 12 months of age, and it had taken five years for Vicki to become pregnant again. "Kenneth, she's so beautiful! She has your mom's nose!" Vicki remarked to her husband. "I think you may be right! It does look like my mother's nose...and it looks like she has your eyes!" Kenneth responded. Both the pregnancy and delivery had gone smoothly. But in the back of their minds, Kenneth and Vicki couldn't help but worry about their baby girl who had died five years before. For the first three months, baby Nicole seemed fine. She was meeting all of her developmental milestones. However, at four months old she developed a severe viral respiratory infection. While her body tried to fight the infection, Nicole began to have problems sucking and turning her head. She wasn't gaining weight as she should. She appeaced to have little appetite, and she began vomiting. She was irritable and cried almost continuously. These symptoms are not characteristic of a respiratory infection. Vicki and Kenneth were afraid because these symptoms seemed very similar to what had happened prior to the death of their first child. "What is going on? I can't believe this is happening again," Kenneth thought to himself. Kenneth and Vicki rushed Nicole to the emergency room. While they waited in the emergency room, Nicole hud a seizure. As the doctors tried to stabilize her, they noticed that Nicole had decreased muscle tone. The ER dactor ordered metabolic screening of Nicole's blood and urine. The doctor also ordered an MRI (magnetic resonaace imaging). While waiting for the results of the screen and the MRI, Kenneth told the doctor that five years ago their first child died mysteriously at 12 months of age after suffering from similar symptoms. A short time later, the results of the blood and urine tests came back. The preliminary tests on Nicole showed she had elevated plasma lactate and pyruvate levels. The MRI showed discrete bilaterally symmetric lesions in the basal ganglia and brain stem. The failure to thrive, regression of developmental skills during a viral infection, vomiting, and seizure suggested that multiple organ systems were being affected. Questions 1. What does the phrase "failure to thrive" mean? 2. What are some reasons why newborn babies "fail to thrive"? 3. What was the event that triggered Nicole's deterioration? 4. What symptoms caused her parents to take her to the doctor? What symptoms presented while at the hospital?