Case 2: Premature Infant With a Fontanelle Bruit

Abstract

During routine weekend rounds, the nurse practitioner notes that an 11-day fontanelle of an infant born at 33 weeks’ gestation is pulsating. She listens with her stethoscope and auscultates a bruit. On examination, the infant is not tachypneic, and there is a soft systolic ejection murmur heard at the left sternal border radiating to the axilla without a gallop. Of note, there is also no hepatomegaly apparent on examination. The remainder of her examination findings are normal. ### History The infant is a twin female born at 331/7 weeks’ gestational age who is being managed in the neonatal intensive care unit (NICU) for prematurity and feeding difficulties. She was born to a 35-year-old, gravida 2, para 0010 woman whose pregnancy was complicated by preeclampsia, preterm premature rupture of membranes, and twin gestation. At birth, the infant weighed 2,285 g (77th percentile), her head circumference was 32 cm (86th percentile), and her Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. Maternal prenatal test results were unremarkable, including a first trimester screen, ultrasonography, and glucose tolerance test. Prenatal medications included prenatal vitamins and one course of betamethasone. The mother denied smoking, alcohol, or drug use during the pregnancy. The infant is breathing comfortably in room air since birth. She is not anemic and is tolerating enteral feeds since they were initiated shortly after birth. She is not yet able to use a nipple for all her feeds, so she is being fed by gavage tube. Her history does not …