A Term Newborn Who Has 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.

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; …