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Floppy neonate with feeding difficulties
  1. Niraj Kumar Dipak,
  2. Shilpa Pandya,
  3. Omkar Hajirnis,
  4. Baliram Pandurang Munde
  1. Department of Peds and Neonatology, Dr L H Hiranandani Hospital, Mumbai, Maharashtra, India
  1. Correspondence to Dr Niraj Kumar Dipak, Department of Peds & Neonatology, Dr LH Hiranandani Hospital, Mumbai, Maharashtra 400076, India; neonatalsciences{at}

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A full-term (40+2/7 weeks) male baby, weighing 2.8 kg, was born to non-consanguineous parents by normal vaginal delivery. He was referred at 9 hours of age with lethargy, poor feeding, feeble cry and generalised hypotonia. On admission, he had normal vitals, and general examination showed bilateral undescended testes (not palpable in the scrotal sac or inguinal canal) with well-developed scrotum, adequate phallus size, and normal urethral and anal opening.

Systemic examination revealed mild to moderate stupor, weak and feeble cry, generalised hypotonia but preserved deep tendon reflexes, and his facial features were notable for retrognathia, high-arched palate and bilateral low-set ears (figures 1 and 2). While evaluating for floppy neonate, features of central hypotonia (very poor sensorium, feeding difficulty and brisk DTRs) were found. After initial stabilisation, Ryle’s tube feeding was started.

Figure 1

Truncal and axial hypotonia.

Figure 2

Facial profile.

Question 1

In central hypotonia, which clinical feature is absent?

  1. Low tone without weakness.

  2. Normal or brisk deep tendon reflexes.

  3. Preserved neonatal reflexes.

  4. Fasciculations. …

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  • Contributors NKD, SP, OH, BPM were involved in the management of the patient, designing the Epilogue and drafting the manuscript. NKD was involved in the review of literature and will act as guarantor. The final manuscript was approved by all the authors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Institutional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.