A Neonate with Abnormal Upper Limbs and Exposed Bowel

Prenatal and Birth Histories

• Born to a 24-year-old, gravida 2, para 1 woman.

• Negative maternal history except for a history of methamphetamine abuse 2 years before the current pregnancy.

• Fetal survey at 20 weeks’ gestation showed gastroschisis; remainder of survey normal.

• Pregnancy also complicated by intrauterine growth restriction and current use of tetrahydrocannabinol and tobacco. She also had pyelonephritis treated with cefazolin.

• Prenatal maternal laboratory tests: group B Streptococcus negative, HBsAg negative, human immunodeficiency virus negative, rapid plasma reagin nonreactive, and rubella immune.

• The woman presented in labor at 36 weeks’ gestation and underwent a cesarean section for nonreactive nonstress test and history of previous cesarean birth.

• Apgar scores were 6 and 7 at 1 and 5 minutes, respectively.

Presentation

The female newborn cried immediately after birth. The exposed bowel was placed immediately in a plastic bowel bag and the infant was positioned on her right side. A nasogastric tube was placed and attached to continuous suction. The neonatology team provided positive pressure ventilation because of poor respiratory effort. Supplemental oxygen was titrated to maintain her pulse oximetry as per Neonatal Resuscitation Program guidelines. She was transferred to the NICU on continuous positive airway pressure (CPAP).

Vital Signs

• Heart rate: 154 beats/min

• Respiratory rate: 30 breaths/min

• Blood pressure: 72/45 mm Hg (mean 47 mm Hg)

• Oxygen saturation: 95% (in room air)

• Temperature: 97.8°F (36.6°C)

Physical Examination (Newborn Day)

• Birthweight = 2,170 g (13th percentile), length = 43 cm (8th percentile), occipitofrontal circumference = 32 cm (40th percentile). …