Expert Opinion :
This child has had 2 episodes of illness. In both these episodes, the infection has not been found. Thus in a neonate with apneic spells, seizures without any infection, one must rule out a metabolic disorder. In this child, there is acidosis. One must rule out mitochondrial disorder, organic acidemia, and other inborn error of metabolism. The baseline workup in form of ammonia, urine aminoacidogram, serum lactate and Pyruvate, and MRI brain will be required. In this child serum, ammonia was 348mcg/dl (elevated). MRI brain was normal and UAA, as well as urine organic acids, were normal. This child is on regular follow-up.