Unusual Abdominal Lesion in a Neonate

Prenatal and Birth Histories:

• 25-year-old G1P0 African American mother

• Estimated gestational age: 24 weeks

• The baby was born by cesarean section following abruptio placentae and had a birthweight of 670 g

• Results of prenatal laboratory investigations, including rapid plasma reagin, human immunodeficiency virus, hepatitis B, sexually transmitted infection screen, and toxicology screen were negative; Group B Streptococcus status was unknown

• Apgar scores were 1 at 1 minute and 7 at 5 minutes

The baby was intubated at birth, two doses of surfactant were administered, and ventilator support was initiated. Umbilical arterial and venous catheters were placed and taped with adhesive dressings. Antibiotics were administered for presumed sepsis and prophylactic fluconazole was administered. The initial hematocrit and platelet count were low, and packed red blood cell and platelet transfusions were provided. The baby developed hyperkalemia and hyperglycemia, which were managed with albuterol, an insulin infusion, and sodium polystyrene.

Seven days after birth, the patient develops abdominal distention. Because esophageal perforation is suggested by abdominal radiography, the orogastric tube is removed. The distention resolves over the next 2 days. The patient is provided a 6-day course of dexamethasone for worsening of respiratory distress.