A 15-day-old girl has abnormally shaped low-set ears, left facial microsomia, and micrognathia suggestive of Goldenhar syndrome. Magnetic resonance imaging (MRI) of the brain reveals colpocephaly, membranous cleft palate, and fluid in the left middle ear cavity. Echocardiography documents normal heart anatomy and function. The infant is feeding well and has appropriate weight gain, but she has occasional decreases in oxygen saturation during feedings. Upper gastrointestinal radiographic study shows massive reflux, prompting the administration of ranitidine and positioning with her head elevated. Despite the reflux precautions, the baby continues to have episodes of low oxygen saturation while feeding, which now occur even at rest. The episodes last for less than 1 minute and are relieved by bag-and-mask ventilation.

Twenty days after birth, she has a generalized clonic seizure. At this time, her glucose concentration is 67 mg/dL (3.7 mmol/L) and ionized calcium concentration is 2.48 mg/dL (0.62 mmol/L) on a...

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