{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:06:59Z","timestamp":1785586019681,"version":"3.56.0"},"reference-count":58,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","theclinics.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Clinics of North America"],"published-print":{"date-parts":[[2025,8]]},"DOI":"10.1016\/j.pcl.2025.03.008","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T07:20:07Z","timestamp":1747725607000},"page":"701-745","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hypotonia in the Newborn Infant"],"prefix":"10.1016","volume":"72","author":[{"given":"Chamindra G.","family":"Laverty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.spen.2008.01.003","article-title":"The evaluation of the hypotonic infant","volume":"15","author":"Bodensteiner","year":"2008","journal-title":"Semin Pediatr Neurol"},{"issue":"4","key":"10.1016\/j.pcl.2025.03.008_bib2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1001\/jamaneurol.2022.0067","article-title":"Multicenter consensus approach to evaluation of neonatal hypotonia in the genomic era: a review","volume":"79","author":"Morton","year":"2022","journal-title":"JAMA Neurol"},{"issue":"4","key":"10.1016\/j.pcl.2025.03.008_bib3","doi-asserted-by":"crossref","DOI":"10.3390\/toxins13040282","article-title":"Muscle tone physiology and abnormalities","volume":"13","author":"Ganguly","year":"2021","journal-title":"Toxins (Basel)"},{"key":"10.1016\/j.pcl.2025.03.008_bib4","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/j.1469-8749.1968.tb02967.x","article-title":"The floopy infant--a practical approach to classification","volume":"10","author":"Dubowitz","year":"1968","journal-title":"Dev Med Child Neurol"},{"key":"10.1016\/j.pcl.2025.03.008_bib5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1469-8749.1960.tb05127.x","article-title":"The \u2018floppy\u2019 infant","volume":"2","author":"Walton","year":"1960","journal-title":"Dev Med Child Neurol"},{"issue":"9","key":"10.1016\/j.pcl.2025.03.008_bib6","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jamapediatrics.2017.1689","article-title":"Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment","volume":"171","author":"Novak","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"2","key":"10.1016\/j.pcl.2025.03.008_bib7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.siny.2010.11.002","article-title":"Genetic evaluation of the floppy infant","volume":"16","author":"Prasad","year":"2011","journal-title":"Semin Fetal Neonatal Med"},{"issue":"4","key":"10.1016\/j.pcl.2025.03.008_bib8","article-title":"Identifying and evaluating young children with developmental central hypotonia: an overview of systematic reviews and tools","volume":"12","author":"Hidalgo Robles","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"10.1016\/j.pcl.2025.03.008_bib9","series-title":"Paralysis and Weakness. Adams and Victor\u2019s Principles of Neurology, 12e","author":"Ropper","year":"2023"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1038\/gim.0b013e31822bead0","article-title":"Prader-Willi syndrome","volume":"14","author":"Cassidy","year":"2012","journal-title":"Genet Med"},{"key":"10.1016\/j.pcl.2025.03.008_bib11","doi-asserted-by":"crossref","DOI":"10.1016\/j.spen.2019.08.007","article-title":"Neuromuscular diseases of the newborn","volume":"32","author":"Fay","year":"2019","journal-title":"Semin Pediatr Neurol"},{"key":"10.1016\/j.pcl.2025.03.008_bib12","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/B978-0-444-64029-1.00021-7","article-title":"Neonatal hypotonia and neuromuscular conditions","volume":"162","author":"Mercuri","year":"2019","journal-title":"Handb Clin Neurol"},{"issue":"2","key":"10.1016\/j.pcl.2025.03.008_bib13","doi-asserted-by":"crossref","first-page":"48","DOI":"10.21315\/mjms2021.28.2.5","article-title":"Deep tendon reflex: the tools and techniques. What surgical neurology residents should know","volume":"28","author":"Lin-Wei","year":"2021","journal-title":"Malays J Med Sci"},{"issue":"12","key":"10.1016\/j.pcl.2025.03.008_bib14","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/j.1469-8749.2008.03097.x","article-title":"Congenital hypotonia: clinical and developmental assessment","volume":"50","author":"Harris","year":"2008","journal-title":"Dev Med Child Neurol"},{"issue":"2","key":"10.1016\/j.pcl.2025.03.008_bib15","article-title":"Neuromuscular junction disorders and floppy infant syndrome: a comprehensive review","volume":"12","author":"Kaler","year":"2020","journal-title":"Cureus"},{"key":"10.1016\/j.pcl.2025.03.008_bib16","doi-asserted-by":"crossref","first-page":"554","DOI":"10.3389\/fneur.2020.00554","article-title":"Myasthenia gravis can have consequences for pregnancy and the developing child","volume":"11","author":"Gilhus","year":"2020","journal-title":"Front Neurol"},{"issue":"15","key":"10.1016\/j.pcl.2025.03.008_bib17","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1080\/14767058.2017.1334048","article-title":"Fetal and neonatal involvement in maternal rheumatologic disease","volume":"31","author":"Iijima","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"key":"10.1016\/j.pcl.2025.03.008_bib18","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/978-3-031-10494-7_35","article-title":"Approach to an infant with hypotonia","author":"Acsadi","year":"2022","journal-title":"Symptom-Based Approach to Pediatric Neurology"},{"key":"10.1016\/j.pcl.2025.03.008_bib19","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/B978-0-323-98818-6.00011-X","article-title":"Neonatal and infantile hypotonia","volume":"195","author":"Younger","year":"2023","journal-title":"Handb Clin Neurol"},{"issue":"2","key":"10.1016\/j.pcl.2025.03.008_bib20","doi-asserted-by":"crossref","first-page":"e540","DOI":"10.1542\/peds.2011-3212","article-title":"Neonatal drug withdrawal","volume":"129","author":"Hudak","year":"2012","journal-title":"Pediatrics"},{"issue":"9","key":"10.1016\/j.pcl.2025.03.008_bib21","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1542\/pir.30.9.e66","article-title":"The floppy infant: evaluation of hypotonia","volume":"30","author":"Peredo","year":"2009","journal-title":"Pediatr Rev"},{"key":"10.1016\/j.pcl.2025.03.008_bib22","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1016\/j.ejpn.2022.04.003","article-title":"Neonatal presentations of neuromuscular disorders","volume":"38","author":"Haliloglu","year":"2022","journal-title":"Eur J Paediatr Neurol"},{"issue":"7","key":"10.1016\/j.pcl.2025.03.008_bib23","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1111\/j.1469-8749.2011.03918.x","article-title":"Genetic evaluation of the pediatric patient with hypotonia: perspective from a hypotonia specialty clinic and review of the literature","volume":"53","author":"Lisi","year":"2011","journal-title":"Dev Med Child Neurol"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.15761\/PD.1000102","article-title":"Dysmorphic neonate: an approach to diagnosis in the current era","volume":"1","author":"Tewari","year":"2016","journal-title":"Pediatric Dimensions"},{"key":"10.1016\/j.pcl.2025.03.008_bib26","unstructured":"Adam MP, Feldman J, Mirzaa GM, editors. GeneReviews\u00ae University of Washington; 1993-2004. Available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK1116\/ (Accessed September 2024)."},{"issue":"5","key":"10.1016\/j.pcl.2025.03.008_bib27","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1038\/s41582-019-0161-9","article-title":"Neurological manifestations of organic acidurias","volume":"15","author":"Wajner","year":"2019","journal-title":"Nat Rev Neurol"},{"issue":"1\u20132","key":"10.1016\/j.pcl.2025.03.008_bib28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10528-017-9825-6","article-title":"Aminoacidopathies: prevalence, etiology, screening, and treatment options","volume":"56","author":"Wasim","year":"2018","journal-title":"Biochem Genet"},{"issue":"4","key":"10.1016\/j.pcl.2025.03.008_bib29","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s11154-020-09568-3","article-title":"Clinical manifestations and management of fatty acid oxidation disorders","volume":"21","author":"Merritt","year":"2020","journal-title":"Rev Endocr Metab Disord"},{"issue":"24","key":"10.1016\/j.pcl.2025.03.008_bib30","doi-asserted-by":"crossref","first-page":"476","DOI":"10.21037\/atm.2018.11.39","article-title":"Lysosomal storage disease overview","volume":"6","author":"Sun","year":"2018","journal-title":"Ann Transl Med"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1750-1172-5-17","article-title":"Congenital hypothyroidism","volume":"5","author":"Rastogi","year":"2010","journal-title":"Orphanet Journal of Rare Diseases"},{"key":"10.1016\/j.pcl.2025.03.008_bib32","series-title":"StatPearls","year":"2024"},{"issue":"3","key":"10.1016\/j.pcl.2025.03.008_bib33","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1529-8027.2012.00412.x","article-title":"Genetic axonal neuropathies and neuronopathies of pre-natal and infantile onset","volume":"17","author":"Yiu","year":"2012","journal-title":"J Peripher Nerv Syst"},{"key":"10.1016\/j.pcl.2025.03.008_bib34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/978-3-030-28829-7_5","article-title":"Neonatal hypotonia","author":"Miralles","year":"2020","journal-title":"Emerging Topics and Controversies in Neonatology"},{"issue":"3","key":"10.1016\/j.pcl.2025.03.008_bib35","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1136\/archdischild-2021-321633","article-title":"Neonatal-onset mitochondrial disease: clinical features, molecular diagnosis and prognosis","volume":"107","author":"Ebihara","year":"2022","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib36","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1002\/mrdd.20048","article-title":"The Dubowitz neurological examination of the full-term newborn","volume":"11","author":"Dubowitz","year":"2005","journal-title":"Ment Retard Dev Disabil Res Rev"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0387-7604(80)80003-9","article-title":"A new approach to the neurological assessment of the preterm and full-term newborn infant","volume":"2","author":"Dubowitz","year":"1980","journal-title":"Brain Dev"},{"issue":"3","key":"10.1016\/j.pcl.2025.03.008_bib38","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/S0022-3476(98)70279-3","article-title":"An optimality score for the neurologic examination of the term newborn","volume":"133","author":"Dubowitz","year":"1998","journal-title":"J Pediatr"},{"issue":"3","key":"10.1016\/j.pcl.2025.03.008_bib39","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.nmd.2009.11.014","article-title":"The children\u2019s hospital of Philadelphia infant test of neuromuscular disorders (CHOP INTEND): test development and reliability","volume":"20","author":"Glanzman","year":"2010","journal-title":"Neuromuscul Disord"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib40","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3233\/JND-221644","article-title":"Can the CHOP-INTEND be used as an outcome measure in the first months of age? Implications for clinical trials and real world data","volume":"11","author":"Cutrona","year":"2024","journal-title":"J Neuromuscul Dis"},{"key":"10.1016\/j.pcl.2025.03.008_bib41","doi-asserted-by":"crossref","DOI":"10.1016\/j.spen.2022.100974","article-title":"A neurologist\u2019s guide to neonatal neurodevelopmental assessments and preterm brain injury","volume":"42","author":"Haffner","year":"2022","journal-title":"Semin Pediatr Neurol"},{"issue":"6","key":"10.1016\/j.pcl.2025.03.008_bib42","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1038\/s41390-022-02310-6","article-title":"Neurological examination at 32-weeks postmenstrual age predicts 12-month cognitive outcomes in very preterm-born infants","volume":"93","author":"Huf","year":"2023","journal-title":"Pediatr Res"},{"issue":"18","key":"10.1016\/j.pcl.2025.03.008_bib43","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1056\/NEJMoa1702752","article-title":"Nusinersen versus sham control in infantile-onset spinal muscular atrophy","volume":"377","author":"Finkel","year":"2017","journal-title":"N Engl J Med"},{"issue":"18","key":"10.1016\/j.pcl.2025.03.008_bib44","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1056\/NEJMoa1706198","article-title":"Single-dose gene-replacement therapy for spinal muscular atrophy","volume":"377","author":"Mendell","year":"2017","journal-title":"N Engl J Med"},{"key":"10.1016\/j.pcl.2025.03.008_bib45","article-title":"Hypoxic-ischemic encephalopathy: pathogenesis and promising therapies","author":"Yang","year":"2024","journal-title":"Mol Neurobiol"},{"issue":"1","key":"10.1016\/j.pcl.2025.03.008_bib46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/1817-1745.205646","article-title":"Neonatal hypoxic-ischemic encephalopathy: a radiological review","volume":"12","author":"Bano","year":"2017","journal-title":"J Pediatr Neurosci"},{"issue":"10449","key":"10.1016\/j.pcl.2025.03.008_bib47","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S0140-6736(24)00495-1","article-title":"Neonatal bacterial sepsis","volume":"404","author":"Strunk","year":"2024","journal-title":"Lancet"},{"key":"10.1016\/j.pcl.2025.03.008_bib48","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3389\/fgene.2013.00057","article-title":"Down syndrome related muscle hypotonia: association with COL6A3 functional SNP rs2270669","volume":"4","author":"Dey","year":"2013","journal-title":"Front Genet"},{"key":"10.1016\/j.pcl.2025.03.008_bib49","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/B978-0-444-54299-1.00006-6","article-title":"Neurological phenotypes for Down syndrome across the life span","volume":"197","author":"Lott","year":"2012","journal-title":"Prog Brain Res"},{"issue":"4","key":"10.1016\/j.pcl.2025.03.008_bib50","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.ncl.2015.07.004","article-title":"Spinal muscular atrophy","volume":"33","author":"Kolb","year":"2015","journal-title":"Neurol Clin"},{"issue":"5","key":"10.1016\/j.pcl.2025.03.008_bib51","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1056\/NEJMoa2102047","article-title":"Risdiplam-treated infants with type 1 spinal muscular atrophy versus historical controls","volume":"385","author":"Darras","year":"2021","journal-title":"N Engl J Med"},{"key":"10.1016\/j.pcl.2025.03.008_bib52","doi-asserted-by":"crossref","DOI":"10.1016\/j.spen.2024.101123","article-title":"Neuromuscular problems of the critically Ill neonate and child","volume":"49","author":"Hayes","year":"2024","journal-title":"Semin Pediatr Neurol"},{"issue":"7","key":"10.1016\/j.pcl.2025.03.008_bib53","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1080\/14740338.2024.2359616","article-title":"Vaccine-associated paralytic poliomyelitis in oral polio vaccine recipients: disproportionality analysis using VAERS and systematic review","volume":"23","author":"Suares","year":"2024","journal-title":"Expert Opin Drug Saf"},{"issue":"5","key":"10.1016\/j.pcl.2025.03.008_bib54","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1177\/088307389601100514","article-title":"Congenital guillain-barr\u00e9 syndrome","volume":"11","author":"Jackson","year":"1996","journal-title":"J Child Neurol"},{"issue":"9044","key":"10.1016\/j.pcl.2025.03.008_bib55","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0140-6736(97)24001-8","article-title":"Guillain-Barre syndrome in mother and newborn child","volume":"349","author":"Luijckx","year":"1997","journal-title":"Lancet"},{"issue":"5","key":"10.1016\/j.pcl.2025.03.008_bib56","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1600-0404.1994.tb02654.x","article-title":"Guillain-Barre syndrome in pregnancy: reflections on immunopathogenesis","volume":"89","author":"Rolfs","year":"1994","journal-title":"Acta Neurol Scand"},{"issue":"12","key":"10.1016\/j.pcl.2025.03.008_bib57","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/S1474-4422(23)00313-7","article-title":"Safety and efficacy of gene replacement therapy for X-linked myotubular myopathy (ASPIRO): a multinational, open-label, dose-escalation trial","volume":"22","author":"Shieh","year":"2023","journal-title":"Lancet Neurol"},{"key":"10.1016\/j.pcl.2025.03.008_bib58","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/B978-0-323-98818-6.00027-3","article-title":"Congenital myopathies","volume":"195","author":"Younger","year":"2023","journal-title":"Handb Clin Neurol"},{"issue":"2","key":"10.1016\/j.pcl.2025.03.008_bib59","doi-asserted-by":"crossref","DOI":"10.3390\/genes13020367","article-title":"Myotonic dystrophies: a genetic overview","volume":"13","author":"Soltanzadeh","year":"2022","journal-title":"Genes (Basel)"}],"container-title":["Pediatric Clinics of North America"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0031395525000422?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0031395525000422?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T20:15:51Z","timestamp":1778271351000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0031395525000422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":58,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["S0031395525000422"],"URL":"https:\/\/doi.org\/10.1016\/j.pcl.2025.03.008","relation":{},"ISSN":["0031-3955"],"issn-type":[{"value":"0031-3955","type":"print"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Hypotonia in the Newborn Infant","name":"articletitle","label":"Article Title"},{"value":"Pediatric Clinics of North America","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pcl.2025.03.008","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}