Rationale: This case highlights the rare yet critical diagnosis of hypermagnesemia in a preterm infant, who presented with symptoms mimicking necrotizing enterocolitis. It underscores the importance of considering hypermagnesemia as a differential diagnosis in neonatal respiratory distress and gastrointestinal symptoms, even when the cause is not immediately apparent. Patient’s Concern: An extremely low birth infant with respiratory distress further had episodes of apnoea and cyanosis. The infant eventually exhibited abdominal distension and bilious vomiting, symptoms mimicking necrotizing enterocolitis. Diagnosis: The infant’s clinical features were attributed to hypermagnesemia, despite no magnesium being administered and no apparent cause identified. Screening the apparently asymptomatic mother confirmed a serum magnesium level of 4 mg/dL, suggesting transplacental transfer as the likely cause of the neonate’s condition. Interventions: The newborn was treated supportively with adequate hydration and maintenance calcium gluconate. Outcomes: Magnesium levels decreased, and the baby showed signs of improvement. Lessons: Hypermagnesemia, though uncommon, should be investigated and considered even when the symptoms are not apparent.
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