Differential Diagnosis for a 3-day-old Premature Boy with Decreased Movements and Seizure
- Single most likely diagnosis:
- Intraventricular hemorrhage (IVH) with post-hemorrhagic hydrocephalus: The patient's symptoms of decreased spontaneous movements, tone, bradycardia, apnea, and a significant increase in head circumference are highly suggestive of IVH, a common complication in premature infants. The development of a generalized seizure further supports this diagnosis, as it can be a consequence of increased intracranial pressure due to hydrocephalus.
- Other Likely diagnoses:
- Sepsis or meningitis: Although the prenatal laboratory studies and ultrasounds were normal, and there was no maternal fever, the patient's symptoms of lethargy, weak cry, and generalized hypotonia could also be indicative of an infectious process, especially given the history of rupture of membranes prior to birth.
- Hypoxic-ischemic encephalopathy: This condition could result from perinatal asphyxia and is consistent with the patient's presentation of decreased movements, tone, and seizure activity.
- Do Not Miss diagnoses:
- Bacterial meningitis: This is a critical diagnosis to consider due to its high morbidity and mortality if left untreated. The patient's symptoms and the history of premature rupture of membranes increase the risk of meningitis.
- Congenital infections (e.g., TORCH infections): These infections can cause neurological symptoms and seizures in newborns and must be considered, especially if other causes are ruled out.
- Rare diagnoses:
- Congenital brain malformations: Although less likely, certain congenital brain malformations could present with similar symptoms, including seizures and increased intracranial pressure.
- Metabolic disorders: Rare metabolic disorders can cause seizures and neurological deterioration in the neonatal period and should be considered if common causes are excluded.