A 15 months old boy who was born at 36 weeks of gestation via C-section to a primigravida 23 years old mother following a pregnancy that was complicated by poor maternal weight gain, oligohydramnios and pyelonephritis. Birth weight was 1.7 kg, and the baby was admitted to NICU for 40 days until his weight reached 2 kg. After discharge, he was noted that his skin was getting darker, and he was very floppy with poor feeding and frequent choking episodes. He has an episode of severe respiratory infection that led to a cardiopulmonary arrest. After successful resuscitation, he was admitted to PICU where he was found to have low cortisol and thyroid hormone levels. He has a history of two seizures. His development has always been delayed, and his development started to regress after that acute illness. He ruled over at 13 months of age, and he currently cannot sit, talk or walk. On examination, he has appendicular hypertonia, axial hypotonia and hyperreflexia with a clonus. His growth parameters at 15 months of age were weight 9.5 kg (25th -50th percentile), height 67.5 cm (<3rd percentile) and head circumference 45.3 cm (on the 10th percentile). Brain MRI showed significant white matter changes.