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The Case
A term newborn presents with a sacral mass.
Prenatal History
23-year-old gravida 3 para 2002 Hispanic mother
Estimated gestational age: 39 4/7 weeks
Blood type O+, antibody screen-negative, rubella immune, hepatitis B surface antigen-negative, VDRL test-nonreactive, Chlamydia-negative, group B Streptococcus (GBS) screen-negative, alpha-fetoprotein-negative
Pregnancy complicated by migraine headaches, treated with hydrocodone/acetaminophen and promethazine
Spontaneous rupture of membranes approximately 10 hours prior to delivery; clear amniotic fluid
Birth History and Presentation
The infant was delivered via precipitous spontaneous vaginal delivery. He cried spontaneously, was placed under a radiant warmer, and was dried and stimulated. Apgar scores were 8 at 1 minute and 9 at 5 minutes. A soft sacral mass, completely covered with skin, was noted immediately. His birthweight was 3,540g.
Case Progression
Vital Signs
Heart rate, 136 beats/min
Respiratory rate, 48 breaths/min
Blood pressure, 58/35 mm Hg
Temperature, 97.9ºF (36.6°C)
Physical Examination
Head: Normocephalic; normal, open, flat fontanelles; symmetric facies; patent nares; intact palate
Lungs: Clear, equal breath sounds; unlabored respirations
Cardiovascular: Normal S1S2; regular rate and rhythm; no murmurs or gallops
Abdomen: Nondistended, soft, nontender; no organomegaly
Genitourinary: Normal term male genitalia; testes descended bilaterally; patent anus
Skeletal: Soft, fluid-filled sacral mass, 3 x 5 x 1.5 cm
Skin: No icterus, birthmarks, or rashes
Neurologic: Alert and active; normal suck; symmetric Moro; …
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