A Newborn Boy Is Being Evaluated in the Nursery the Day

question 670

Multiple Choice

A newborn boy is being evaluated in the nursery the day after delivery.  The patient was born to a 26-year-old primigravid woman via spontaneous vaginal delivery at 39 weeks gestation.  He was poorly arousable at delivery and required manual stimulation and brief oxygen supplementation.  Apgar scores were 5, 6, and 8 at 1, 5, and 10 minutes, respectively.  Birth weight and length were appropriate for gestational age.  Temperature is 37.6 C (99.7 F) and oxygen saturation is 98% on room air.  The patient arouses with an exaggerated startle reflex when examined.  Cardiopulmonary examination is difficult due to his shrill cry throughout the evaluation but appears unremarkable.  All limbs have a mild generalized hypertonicity, and there is rapid shaking of the upper extremities that resolves with passive movement of the limbs.  Glucose level is 75 mg/dL.  Leukocyte count is normal, and no bands are present.  Which of the following is the best next step in management of this patient?

• A)Administer phenobarbital therapy
• B)Obtain blood cultures
• C)Obtain plasma amino acid levels
• D)Obtain urine drug screen
• E)Provide supportive care only

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