A 3-Day-Old Boy Is in the Neonatal Intensive Care Unit

A 3-day-old boy is in the neonatal intensive care unit for management of prematurity.  For the past hour, the patient has had decreased spontaneous movements and tone.  He has also had one episode of bradycardia and apnea.  The patient was delivered vaginally at 28 weeks and 5 days gestation by a multiparous woman with cervical insufficiency.  Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.  Birth weight was 1.04 kg (2 lb 5 oz) .  Prenatal laboratory studies and ultrasounds were normal.  Rupture of membranes occurred 3 hours prior to birth.  The amniotic fluid was clear, and there was no maternal fever.  Temperature is 37.1 C (98.8 F) .  Head circumference is 28.5 cm, an increase of 3 cm from yesterday.  Examination shows a lethargic neonate with a weak cry, tense fontanelle, and generalized hypotonia.  The patient then develops a generalized seizure.  Which of the following is the most likely cause of this patient's condition?

A) Hypocalcemia
B) Hypoglycemia
C) Hypoxic ischemic encephalopathy
D) Inborn error of metabolism
E) Intraventricular hemorrhage
F) Meningitis

Correct Answer:

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