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American Academy of Pediatrics
Visual Diagnosis

A Newborn with a Transilluminant Head

Samuel Julian and Akshaya Vachharajani
NeoReviews October 2016, 17 (10) e630-e632; DOI: https://doi.org/10.1542/neo.17-10-e630
Samuel Julian
*Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
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Akshaya Vachharajani
*Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
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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: …

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NeoReviews
Vol. 17, Issue 10
1 Oct 2016
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A Newborn with a Transilluminant Head
Samuel Julian, Akshaya Vachharajani
NeoReviews Oct 2016, 17 (10) e630-e632; DOI: 10.1542/neo.17-10-e630

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A Newborn with a Transilluminant Head
Samuel Julian, Akshaya Vachharajani
NeoReviews Oct 2016, 17 (10) e630-e632; DOI: 10.1542/neo.17-10-e630
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More in this TOC Section

  • Severe Intrauterine Growth Restriction, Thrombocytopenia, and Direct Hyperbilirubinemia in a 26-week Premature Infant
  • An Unexpected Brain Lesion in a 2-month-old Infant
  • A Large Tortuous Umbilical Cord with Superficial Abdominal Wall Varicose Veins in a Newborn
Show more Visual Diagnosis

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