Case 2: The Inconsolable Newborn

Presentation

A 5-day-old male newborn of 39 weeks’ gestational age was brought to the emergency department (ED) with a complaint of “shaking of upper and lower extremities and fussiness” since birth. After the initial episode at home, he presented to the primary care physician with 2 more shaking episodes that occurred in clusters of 3 minutes described as jerking of both upper and lower extremities with occasional head jerking. The shaking is not associated with eye rolling or with feeds. Concerned about possible seizures, the physician recommended admission to the NICU for further evaluation. The patient did not have a fever, rash, or upper respiratory tract infection symptoms. There was 1 episode of nonbilious, nonbloody vomiting on the day of presentation. He had 10 to 11 wet diapers per day and 8 to 9 stools per day. There was no change in alertness and energy.

He is a term infant, born by repeat cesarean delivery to a 32-year-old gravida 5-3-0-2-3 mother, who had received adequate prenatal care. The pregnancy was pertinent for a history of Escherichia coli–positive urinary tract infection at 24 weeks’ gestation and a medical history that included a Chlamydia infection, which had been diagnosed and treated before this pregnancy. Fetal movement and cervical examination findings were normal. She was group B Streptococcus negative, rapid plasma reagin test nonreactive, rubella immune, and hepatitis B surface antigen …