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Feeding problems in a lethargic infant (Case Presentation)

CASE PRESENTATION A 5-week-old male infant was referred to the emergency department because of progressive feeding difficulties, vomiting and insufficient weight gain that had lasted for 1 week. The parents had not observed any signs of infection, including fever or hypothermia. The pregnancy was uneventful, and the boy was born after 36 weeks and 6 days, with a birthweight of 2150 g (p5) and a head circumference of 32.5 cm (p10). Apgar scores were nine and 10 after one and 5 min, respectively. At the time of delivery, the results of screening for maternal group B streptococcus were not yet known and the mother received no intrapartum antibiotic prophylactic treatment. The boy was admitted to hospital after birth because of his low birthweight and observed for signs of infection. Maternal cultures yielded positive for group B streptococcus after the infant was admitted, but because there were no signs of early neonatal infection, no antibiotic treatment was given, according to current national guidelines. The patient was discharged from hospital in a good clinical condition after 10 days. However, 3 weeks after discharge from hospital, he had difficulty drinking his bottles and he became lethargic. Physical examination showed a dystrophic, lethargic infant who was afebrile, with a weight of 2345 g and head circumference of 36.5 cm (p25). Blood pressure was 81/44 mmHg, heart rate was 140/min, breathing was irregular at 47/min, and he had several apnoeas. His fontanel was bulging, his corneal reflex was absent on the