A female infant is born at 30 weeks of gestation via vaginal delivery due to imminent labor. The infant receives 1 dose of surfactant in the delivery room for respiratory distress, after which she is transferred to the NICU for further care. Anthropometric measurements at birth are: weight, 595 g; length, 29 cm; and head circumference, 23.5 cm. Birthweight, length, and head circumference are below the 5th percentile for the corresponding gestational age. Wide forehead, 2 natal teeth on the mandibular ridge, hypertonia of all extremities, grade 2 systolic murmur, and bilateral inguinal hernias are noted on examination. Specific immunoglobulin M values for toxoplasma, rubella and cytomegalovirus virus are negative. Head ultrasonography reveals no calcifications or other abnormalities. Skeletal survey shows no signs of perichondritis. Retinal examination to check for signs of chorioretinal inflammation that could point toward a particular TORCH (toxoplasmosis, other [syphilis, varicella-zoster, parvovirus B19], rubella, cytomegalovirus, and herpes) infection are negative. Peripheral pulmonary arteries are found to be mildly hypoplastic on echocardiography, which is conducted as part of an evaluation for an audible murmur. Ultrasound imaging of kidneys and bladder reveals no anatomic abnormalities. The patient undergoes elective extubation 24 hours after birth. She makes a transition to room air within 72 hours after birth. After extubation, she has a …