A Newborn with a Transilluminant Head

Samuel Julian; Akshaya Vachharajani

doi:10.1542/neo.17-10-e630

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The Case

A 1-day-old late preterm neonate has a large head.

Prenatal and Birth Histories

Born to a 26-year-old gravida 4, para 3 mother with negative prenatal laboratory screening. Maternal group B Streptococcus colonization status is not known.
Infant was born by cesarean section at a late preterm gestational age.
Infant cried at delivery but made grunting sounds and displayed increased work of breathing, requiring endotracheal intubation and surfactant therapy. Apgar scores were 8 and 8 at 1 and 5 minutes, respectively.
Birthweight was 3,480 g (>95th percentile); length, 52.5 cm (>95th percentile); and head circumference, 51.5 cm (>99th percentile).

Presentation

Heart rate: 107 beats per minute
Respiratory rate: 57 breaths per minute
Blood pressure: 89/51 mm Hg
Saturation: 100% (fraction of inspired oxygen of 1.0)
Temperature: 97.5°F (36.4°C)

Physical Examination (Day 1)

Head: Large head; large, full anterior and posterior fontanelles with widely spaced sutures; transillumination of head was performed (Fig 1); no facial dysmorphism
Skin: Pink, capillary refill time 2 seconds
Oral cavity: Oral endotracheal tube in situ; pink mucosa and intact palate
Neck: No lymphadenopathy
Lungs: Breathing comfortably while receiving mechanical ventilation; clear equal breath sounds, no retractions noted
Cardiovascular: Normal S1 and S2; regular rate and rhythm; no murmurs or gallops
Abdomen: Nondistended and soft to palpation, bowel sounds appreciated, liver edge palpated 2 cm below the right costal margin, no splenomegaly
Genitourinary: Genitalia appeared normal for sex and gestational age; testes descended bilaterally
Extremities: No abnormalities of the long bones, hands, or feet
Neurologic: …