Newborn delivered SVD,poor activity n poor sucking since birth. Cry on stimulation + . Eye opening + , CVS :- normal , chest:- clear ,P/A:- soft n bowel sound + , Ant.Fontonelle:- normal. Tc:- 8000 ,CRP:- 25 , B.Sugar :- 90. Dx n Mx :- ?

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D/×Congenital rickets D/d sepsis, hyperthyroidism,congenital syndrome Adv T3 T4 TSH , s.calcium

Hi Dr Sunil Something we r missing here Very interesting case Newborn Vaginally delivered Poor suck Tone normal TC normal B sugar normal CRP elevated I think of some maternal intoxication or drug intake prior to delivery Second is syndromic /genetic CAUSE Third Is IEM

But again poor suck normal tone doesn't go hand in hand Can Think of myopathy as one more DD
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Has the passed meconium?

Yes
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Seems like case of perinatal asphyxiation , Is there any history of PROM? Apgar 1,5,20 minute Dr Sunil?? Any subtle convulsions?? Or excessively jittery @Dr. Sunil Soni

No seizure/ jitteriness, no PROM , Apgar was 9. Cried after birth +
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Poor activity, poor suck with normal tone.. reflexes? Antenatal history? CRP s/o EOS.. Flat ribs normal in neonate but ICS wider then usual.. Need LP, blood culture, s calcium, vit d3 levels, thyroid profile and CPK. Then nxt line of metabolic screening.

This Infant with poor suck & activity : D/D : HYPOTONIA DUE TO CNS LESIONS. SYNDROMIC DISORDERS. INTRAPARTUM SEPSIS. TORCH INFECTIONS. DOWN SYNDROME.

Tone is normal Face is normal
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Send blood c/s n treat neonatal sepsis with first line antibiotics . R/o myopathy and congenital hypothyroidism.

@Dr. Sunil Soni rule out werding Hoffman disease ,advise CPK, Another investigations like IONIZED CALCIUM, TSH , PTH,

Thnx Sir...
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Dear Dr. Sunil What's wt & term? Baby is mostly lethargic RBS-N TC-WNL CRP +ve Plz do S. Calcium, TSH Eectrolytes Blood culture Is there hypotonia 2D Echo Dx EO sepsis/ meningitis Hypothyroidism Wording Hoffman

Thnx sir Wt:- 2.6kg Tone is normal No floppiness
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Sepsis screening

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