Photo Quiz

Newborn with Arm Deformity

 

Am Fam Physician. 2017 Feb 15;95(4):255-256.

A 25-year-old Hispanic woman delivered at 40 weeks' gestation by spontaneous vaginal delivery. Prenatal care was started late at 28 weeks' gestation, and routine laboratory screening showed no abnormalities. Prenatal ultrasonography at 29 weeks' gestation showed a horseshoe, pelvic kidney in the mother. She had no history of infections or recent travel and was not taking any medications other than prenatal supplements. Her two prior deliveries were unremarkable.

At birth, the newborn appeared healthy, and had a lusty cry and no visible craniofacial or cutaneous abnormalities. Cardiovascular and pulmonary assessments were normal. Examination revealed bilateral wrist flexion and shortened forearms (Figures 1 and 2). The humerus was palpable in the upper arm bilaterally. The newborn had normal thumb development and handgrip bilaterally. He had all 10 fingers, with webbing noted on both hands. Skeletal and joint examination was otherwise unremarkable, including normal hip rotation and lower extremity length.

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Figure 1.


Figure 1.

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Figure 2.


Figure 2.

Birth weight was 6 lb, 9 oz (2,975 g). Apgar score was 9 at one and five minutes. Pulse and respiratory rate were normal. Initial laboratory results showed a leukocyte count of 24.8 per μL (0.02 × 109 per L), normal range: 9,000 to 30,000 per μL (9 to 30 × 109 per L); hematocrit of 42.8%, normal range: 42.0% to 60.0%; and platelet count of 146 × 103 per μL (146 × 109 per L), normal range: 150 to 400 × 103 per μL (150 to 400 × 109 per L).

Question

Based on the patient's history and the newborn's physical examination findings, which one of the following

Author disclosure: No relevant financial affiliations.

Address correspondence to Javidhya Dasarathy, MD, at jdasarathy@metrohealth.org. Reprints are not available from the authors.

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This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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