Case 3: A Term Newborn with Intrauterine Growth Restriction and Severe Fetal Brain Anomalies

Abstract

A 29-year-old gravida 4, para 3 woman is seen by the maternal-fetal medicine team because of abnormal ultrasonographic findings at 34 weeks of gestation. The fetus has severe intrauterine growth restriction (IUGR) (<1st percentile) and multiple organ abnormalities, including microcephaly, small forebrain, scalloped parietal bones, bilateral ventriculomegaly, dilated third ventricle, splayed thalami, irregular falx, scattered intracranial calcifications, and a small, flattened forehead. Fetal echocardiography shows levorotation of the cardiac axis, tortuous ductus arteriosus, and tricuspid valve thickening. Her prenatal history is notable for travel to the Dominican Republic until 12 weeks of gestation. She denies any fever, insect bites, rash, conjunctivitis, or arthralgia. Findings on other prenatal laboratory screening are reassuring. After the induction of labor for IUGR, a male infant is delivered at 37 2/7 weeks of gestation via normal spontaneous vaginal delivery. Brief positive pressure ventilation is given in the delivery room for an initial low heart rate. The heart rate quickly recovers, but respiratory distress develops, requiring continuous positive airway pressure (CPAP). The infant is transferred to the NICU with the administration of CPAP. Upon admission, physical examination shows a boy with a birthweight of 2,140 g (2.8th percentile), length of 40.5 cm (<1st percentile), and head circumference of 29 cm (<1st percentile). Pertinent findings include microcephaly and global hypertonia, along with contractures of the upper and lower extremities (Fig 1). Figure 1. Contractures of upper and lower extremities. …