Case 2: A Salty Baby

A male term neonate is born to a 25-year-old, gravida 3 woman in a third-degree consanguineous marriage with 2 previous term neonatal deaths. Her first child was male and had an unexplained death at 14 days of age at home. Her second child was female and also had an unexplained death at 11 days of age. The antenatal period during this current pregnancy is uneventful except for a diagnosis of gestational diabetes mellitus, which required treatment with insulin during the third trimester. The woman’s blood glucose values were maintained in the normal range in the antepartum and intrapartum periods. Her antenatal scans are normal. This neonate is delivered at 38 weeks of gestation via a planned lower-segment cesarean section (LSCS) in view of a previous LSCS and a history of 2 unexplained neonatal deaths. The neonate cries immediately after birth and does not require any resuscitation. His Apgar scores are 8, 8, and 9 at 1, 5, and 10 minutes after birth, respectively. The placenta weighs 380 g and is normal on gross examination. The infant’s birthweight, length, and head circumference are 3,650 g (86th percentile), 51 cm (77th percentile), and 35.5 cm (86th percentile), respectively. The initial examination findings are normal and show that the infant does not have any obvious external anomalies, edema, or facial dysmorphisms; no skin lesions, limb abnormalities, or genital abnormalities are noted. Blood glucose monitoring performed as per protocol and all test results are normal. Because of the history of 2 previous neonatal deaths, electrocardiography, echocardiography, and cranial ultrasonography are performed before discharge, results of which are all normal. The expanded newborn screening panel is sent before discharge. The neonate is discharged from the hospital on day 4 after birth and the family is advised to follow-up closely with the pediatrician. On the 7th …