Differential Diagnosis for a Term Infant Shaking Periodically

Single Most Likely Diagnosis

• Hypocalcemia: This condition is a common cause of tremors or shaking in newborns, especially in the first few days of life. It can occur due to various reasons such as maternal diabetes, preterm birth, or birth asphyxia, but can also be seen in term infants without any specific risk factors.

Other Likely Diagnoses

• Neonatal Seizures: Although the question mentions normal sugars and no opioid exposure, seizures can still occur due to other causes such as infection, structural brain abnormalities, or metabolic disorders. The presentation can sometimes be subtle, with shaking or tremors being part of the seizure activity.
• Jitteriness: This is a common benign condition in newborns characterized by tremors or shaking, often in response to stimuli. It can be distinguished from other conditions by its characteristic pattern of occurring in response to handling or stimulation and resolving when the infant is swaddled or given a pacifier.

Do Not Miss Diagnoses

• Intracranial Hemorrhage: Although less common, an intracranial hemorrhage can cause seizures or abnormal movements, including shaking. This condition is critical and requires immediate diagnosis and treatment to prevent long-term neurological damage.
• Infection (Meningitis or Sepsis): Infections can cause a wide range of symptoms in newborns, including abnormal movements. Early recognition and treatment of infections are crucial to prevent serious complications.
• Congenital Neurological Disorders: Certain congenital disorders affecting the brain or nervous system can cause abnormal movements or seizures. While these may not be the first consideration, they are important to rule out due to their potential impact on the infant's long-term health and development.

Rare Diagnoses

• Metabolic Disorders: Certain metabolic disorders, such as those affecting amino acid or organic acid metabolism, can present with neurological symptoms including seizures or abnormal movements. These conditions are rare but important to consider due to the availability of specific treatments that can significantly improve outcomes.
• Benign Familial Neonatal Epilepsy: This is a rare genetic condition that causes seizures in newborns. It is usually inherited in an autosomal dominant pattern and typically has a good prognosis with appropriate treatment.