EBMedicine

What’s Your Diagnosis? Seizures in Neonates: Diagnosis and Management in the Emergency Department

Welcome to this month’s What’s Your Diagnosis Challenge!

Case Presentation: Seizures in Neonates: Diagnosis and Management in the Emergency Department

An EMS team brings in a 5-day-old boy with a history of a rhythmic, left-arm-shaking episode at home. The parents tell you the pregnancy was normal and the birth was a full-term, normal spontaneous vaginal delivery. The baby had been doing well until yesterday, when he started eating less and not waking up for feeds. The baby has low tone with a tense anterior fontanelle, and his temperature is 35.8?C (96.4?F). What workup is warranted at this time?

Conclusion

Given the hypothermia and bulging fontanelle in the 5-day-old boy, you were highly suspicious of an infectious etiology. You obtained a lumbar puncture, blood culture, urinalysis/urine culture, CBC, and BMP. You administered broad-spectrum IV antibiotics, acyclovir, and a normal saline bolus. The CBC was remarkable for leukocytosis and left shift with bandemia. You admitted the patient for presumed meningitis.

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