This case is written by Dr. Suzan Schneeweiss. She is a staff physician at Sick Kids Hospital in Toronto and is the Director of Education for the Division of Pediatric Emergency Medicine at the University of Toronto.
Why it Matters
The differential diagnosis for any sick neonate is always broad. This case, in particular, addresses the differential diagnosis and management of a seizing neonate. It highlights the following:
- The need for anti-epileptics in a neonate with seizures in the context of trauma
- The importance of including a septic work-up and broad antibiotic/antiviral coverage in the management of a seizing neonate
- The need to consider non-accidental injury
Clinical Vignette
A 1 month-old male is brought into the ED due to poor feeding and lethargy. The baby was apparently well until this morning, when his mom noticed it was difficult to wake and feed him. There has been no fever. The baby vomited once this morning, and is voiding and stooling normally.
The nurse in triage notices abnormal movements and brings the baby in to your team in the resuscitation room.
Case Summary
The team has been called to help in the ED after a 1 month-old male is brought in seizing. The team is expected to manage the seizure, but then will subsequently realize on examination there are concerning signs for non-accidental trauma, specifically head injury. The team will be expected to establish definitive airway management and consult with PICU and local child protection services.
Download the case here: Non-Accidental Trauma
CXR for the case found here:
(CXR source: https://radiopaedia.org/articles/neonatal-pneumonia)
EM Sim Cases 