Index of Suspicion in the Nursery

Abstract

A 2-month-old male baby is admitted to the hospital for the third time with a history of abnormal movements since the first day after delivery. He returns to the hospital on this occasion due to the appearance of bluish skin associated with the occurrence of abnormal movements that persist despite the use of anticonvulsant medication. The parents describe the abnormal movement as a sudden, startling jump followed by a forceful body contraction in which the baby becomes rigid, with fists firmly clenched, arms flexed, spine erect, head tilted slightly backward, and legs extended. He remains awake during and after the episode. The contraction lasts for approximately 10 seconds and is followed by floppiness for 1 to 2 seconds. Sometimes episodes are accompanied by a bluish coloration of the entire body. Startling sounds or even a sudden touch trigger the episodes, which occur frequently all day long. They explain that firm holding and hugging sometimes seem to stop the episodes. On questioning, they report no eye rolling, blinking, or lip smacking during the episodes, and the episodes usually are not preceded by feedings. The boy has good suckling and appetite; no constipation or diarrhea; and is active, afebrile, and seemingly otherwise healthy. A review of the pregnancy and delivery reveals no complications or infections during the pregnancy, although the mother says that the movements of the baby in the womb seemed different from those in …