Case 22:

History - A 30wk male neonate, triplet 1 of IVF pregnancy, was delivered by LSCS for premature onset of labour. A/N history showed that it was an IVF pregnancy tri-chorionic tri-amniotic (TCTA), otherwise uneventful. He was found to have shallow breathing and was admitted to NICU for observation. He was later transferred from NICU to SCBU on Day 32 of life with nasal cannula. Other triplets were relatively "normal" and were discharged at the 3rd week of life.

He was noted to have poor sucking and increased oxygen requirement during feeding. His weak respiratory effort and poor sucking persisted for 2 months. Physical examination reveals non-paralytic hypotonia, active movement of all 4 limbs and preserved tendon reflexes. Moro reflex was incomplete. Bilateral cryptochidism was also noted. Ultrasound examination showed structurally normal brain. Conventional karyotype was normal.

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Q1 - What is your approach to this "hypotonic infant"?

For comments and questions, please send email to: Dr. Brian Chung (bhychung@hkucc.hku.hk)

Dr. Brian Chung, Dr WL Yang, and Wong Wui Bun and Zhu Yi Dan (2007 SSM student)

Acknowledgement: Special Thanks to

Dr P Lee and 2007 SSM "Clinical Genetic" Teaching Group

Dr KY Wong and neonatal Team for case management & recruitment

Department of Paediatrics & Adolescent Medicine;
The University of Hong Kong