P132 – 2903: A newborn with poor feeding and a mask-like face

Abstract

Case presentation A male newborn, the child of nonconsanguineous parents, presents with poor feeding with difficulty in swallowing, drooling of saliva and clubfeet. He had been delivered by cesarean section 3 days earlier at term with normal body weight, length and head circumference. The boy is non-toxic in appearance and without distress. Both feet appear inverted and adducted with an inability to bring them to midline. The extremities are flexed with normal Moro-, Galant-, walking-, palmar- and plantar reflexes. The face appears symmetric and masklike with mimicking features when crying hardly differing from those at rest. The child is not able to follow laterally an object moving horizontally, no blink is noted when a bright light is shone in his eyes, the sucking reflex is weak and the tongue movements are poor. In retrospect the parents reported the use of misoprostol during the first trimester of pregnancy in an attempt to terminate pregnancy. Discussion Non-traumatic congenital bilateral abducens and facial weakness, the most consistent abnormalities noticed in our newborn are essential clinical features of Mobius syndrome, a condition that is diagnosed clinically. This syndrome results from a developmental anomaly of the rhombencephalon that occurs between the 6th and 12th gestational week. The term Mobius syndrome, which was initially used exclusively to define a congenital bilateral facial weakness associated with restriction of horizontal eye movements, has been subsequently expanded to include palsies of other cranial nerves as well as other malformations, such as cranio-facial and oro-facial anomalies and limb malformations that sometimes concurrently occur. The causes of the syndrome include genetic, ischemic, infectious and above all teratogenic factors such as the ingestion of drugs like cocaine, alcohol, ergotamine derivatives, thalidomide, benzodiazepines, and especially, like in our case, the prostaglandin analogue misoprostol (often used for uterine evacuation in pregnancy).