A 3-Week-Old Boy Is Brought to the Emergency Department Due

A 3-week-old boy is brought to the emergency department due to lethargy for a day.  The patient was breastfeeding well until this morning, when he became increasingly difficult to arouse.  He was born full-term to a 35-year-old mother who had a spontaneous vaginal delivery at home.  She took prenatal vitamins throughout pregnancy and received routine prenatal care.  However, the boy did not receive any vaccinations or medications after birth due to parental preference for a "natural" newborn period.  Family history is unremarkable.  Head circumference is at the 99th percentile.  Weight and length are at the 25th percentile.  Physical examination shows a large, bulging anterior fontanel.  The eyes appear driven downward and the patient is not able to track upward.  No scalp swelling is present.  Intracranial hemorrhage is confirmed on head CT scan.  Which of the following is the most likely cause of this infant's condition?

A) Abusive head trauma
B) Bacterial meningitis
C) Birth injury
D) Germinal matrix fragility
E) Impaired clotting factor carboxylation

Correct Answer:

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