Approach to hypotonia (newborn and infant) Quiz: Ace Your Exams

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A newborn boy delivered at term is evaluated in the neonatal intensive care unit (NICU) at 2 days of life due to feeding difficulties and choking episodes. Pregnancy and delivery were uneventful. The mother takes pyridostigmine for a chronic disorder but was asymptomatic throughout pregnancy. The infant has poor sucking during breastfeeding. Weight is 2900 gTemperature is 37°C (98.6°F), pulse is 130/min, respirations are 45/min, blood pressure is 70/38 mm Hg, and oxygen saturation is 97% on room airOn examinationthe newborn demonstrates a weak cry, bilateral ptosis, and generalized hypotonia with preserved reflexes. Cardiopulmonary and abdominal exams are unremarkable. Complete blood count (CBC), C-reactive protein, and creatinine kinase (CK) are within normal limitsElectromyography (EMG) and nerve conduction studies (NCS) demonstrate a decremental response of the compound muscle action potential with repetitive nerve stimulation. Which of the following findings is expected in the laboratory evaluation of this patient? 

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