A 2-week-old Infant Presenting with Seizures

Prenatal and Birth Histories

• • Born to a 32-year-old, gravida 1, para 0 woman

• • Pregnancy was complicated by gestational hypertension, diet-controlled type 2 diabetes, and tobacco use

• • Prenatal laboratory findings: Group B Streptococcus (GBS) positive; otherwise unremarkable

• • Born at 38 4/7 weeks’ gestation via urgent cesarean section because of a nonreassuring fetal heart rate

• • Apgar scores: 8 and 9 at 1 and 5 minutes, respectively; the infant required 2 minutes of blow-by oxygen

• • Birthweight = 3,665 g (73rd percentile), length = 52 cm (82nd percentile), head circumference = 35 cm (61st percentile)

• • Admitted to the NICU for hypoglycemia, with a glucose level of 18 mg/dL (1 mmol/L) at 2 hours of age. He required 2 boluses of 10% dextrose. Glucose level was stabilized within 4 hours with dextrose-containing intravenous fluids. As a result of mild respiratory distress, nasogastric feedings were initiated. Respiratory distress was presumed to be caused by transient tachypnea of the newborn, and the infant required high-flow nasal cannula until 4 days of age. Complete blood cell count with differential was normal, C-reactive protein was elevated to 7.24 mg/dL (72.4 mg/L; range, 0.10–1 mg/dL [1.0-10.0 mg/L]), and blood culture yielded no growth

• • Discharged at 7 days of age in room air and full oral feeding without any concerns

Presentation

The infant began having abnormal movements at 14 days of age that were described by his parents as episodes of rightward deviation of the head and eyes, as well as right arm and leg jerking that lasted for 20 seconds and occurred every few hours. Between events, the infant acted appropriately and was feeding well, with good urine output. Overnight, the parents thought that he was fussy and had …