TY - JOUR T1 - Floppy neonate with feeding difficulties JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed SP - 160 LP - 162 DO - 10.1136/archdischild-2017-314517 VL - 104 IS - 3 AU - Niraj Kumar Dipak AU - Shilpa Pandya AU - Omkar Hajirnis AU - Baliram Pandurang Munde Y1 - 2019/06/01 UR - http://ep.bmj.com/content/104/3/160.abstract N2 - 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.In central hypotonia, which clinical feature is absent?Low tone without weakness.Normal or brisk deep tendon reflexes.Preserved neonatal reflexes.Fasciculations. … ER -