Newborn With Thin Fiber Connecting Upper and Lower Eyelids

Christiana N. Oji-Mmuo

doi:10.1542/neo.15-5-e216

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The Case:

A newborn presents with a thin hairlike fiber connecting the medial aspect of her upper and lower eyelids vertically (Fig 1).

Figure 1.

Prenatal and Birth Histories:

35-year-old G3P2 white mother.
Estimated gestational age: 33 weeks.
Prenatal sonogram was significant for polyhydramnios choroid plexus cysts, and intrauterine growth restriction. Prenatal genetic testing was offered but declined by family. The mother presented to the labor and delivery room in preterm labor and fetal distress. The infant was delivered by emergency cesarean delivery because of fetal bradycardia and possible placental abruption.
Group B Streptococcus status was unknown; hepatitis B surface antigen–negative; Rubella immune, rapid plasma reagin negative, and human immunodeficiency virus status otherwise not available.
Apgar scores were 2, 6, and 7 at 1, 5, and 10 minutes after birth, respectively. Infant required bag mask ventilation for no respiratory effort. She responded well to resuscitation with improvement in heart rate, color, and oxygen saturation. She was transitioned to mask continuous positive airway pressure (CPAP) before transfer to the neonatal intensive care unit (NICU).

Presentation:

The infant was doing well on nasal CPAP upon arrival to the NICU. However, she would develop respiratory distress upon discontinuation of CPAP mask. The nursing staff reported difficulty passing a nasogastric feeding tube, raising a suspicion of choanal atresia.

The admitting house staff and nurse noted a thin threadlike tissue connecting the eyelids vertically. This was initially thought to be a strand of hair, but could not be rubbed off by wiping.