Index of Suspicion in the Nursery

Abstract

A male infant is born at 324/7 weeks of gestation with a birth weight of 2,870 g. He is born to a 27-year-old gravida 2, para 1001 mother who received appropriate prenatal care. The infant is noted to have severe isolated abdominal ascites on a 21-week ultrasonogram, which is confirmed with subsequent ultrasonography. No pleural or pericardial effusion, skin edema, or structural abnormalities in the heart are noted. Doppler ultrasonography reveals normal middle cerebral artery velocity. The mother’s blood group is O+, antibody test result is negative, and serologic test results for hepatitis B, human immunodeficiency virus, and syphilis are negative. The mother is rubella immune and tests group B Streptococcus negative. The results of Neisseria gonorrhea and Chlamydia tests are negative. IgM test results are negative for toxoplasma, parvovirus, varicella zoster virus, and cytomegalovirus. The mother presents with premature rupture of the membranes, which occurs 16 hours before delivery, and receives 2 doses of betamethasone. Before an elective low transverse caesarean delivery, 1.5 L of clear fluid is removed through amniocentesis and 180 mL through paracentesis secondary to concerns of fetal lung immaturity and abdominal distension. The infant is electively intubated at delivery in anticipation of respiratory distress from extensive ascites, administered one dose of surfactant, and given mechanical ventilatory assistance. Apgar scores are 6 and 8 at 1 and 5 minutes, respectively. The infant passes urine and meconium soon after birth. On physical examination, the infant is noted to have a distended abdomen and bilateral scrotal edema. Cord arterial and venous blood gas …