A 1-day-old girl presents with bilateral pedal edema at birth (Fig 1). She was born at 37 weeks’ gestation to a 29-year-old now gravida 5, para 3 mother who received poor prenatal care. The mother's blood type is O Rh+, she is rubella immune, and the results of serologic testing are negative for hepatitis surface antigen, syphilis, and human immunodeficiency. Pregnancy was complicated by pancreatitis, and the infant was born via repeat cesarean delivery complicated by late decelerations. Her Apgar scores were 7 and 9 at 1 and 5 minutes, respectively.

On presentation to the nursery, the infant appears in no apparent distress, is alert, and has a weight of 3,020 g (20th percentile), a length of 46 cm (25th percentile), a chest circumference of 34 cm (>90th percentile), and a head circumference of 33 cm (50th percentile). Examination of the head is significant for posteriorly rotated auricles...

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