A 6-Week-Old Girl with Generalized Edema of Unknown Etiology

Abstract

A6-week-old girl was admitted for worsening generalized edema of unknown etiology. She was the 2,880-g product of a 32week gestation to a 32-year-old G1P1 woman. Pregnancy was complicated by ultrasound discovery of ascites at 31 weeks that had not been present at 21 weeks. TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex) virus and parvovirus titers of the mother were negative. On the day of delivery, scalp edema was noted by ultrasound and delivery was induced vaginally. Apgar scores were 8 at 1 minute and 9 at 5 minutes. Physical examination at birth included appropriate-for-gestationalage growth parameters, no dysmorphic features, normal cardiac exam, three-vessel umbilical cord, ascites, and facial and scalp edema. Pertinent laboratory tests in the newborn nursery included: hemoglobin 14.3 g/dL with normal white blood cell differential and platelet count, hemoglobin 9.6 g/dL on day 3 of life with 6% reticulocytes and 9 nucleated red blood cells/high-powered field, peak bilirubin (total/direct) of 9.8/0.3 mg/dL on day 3 of life, albumen 2.4 mg/dL, normal serum transaminases, negative cytomegalovirus DNA by polymerase chain reaction, normal karyotype and whole genome micro-