A full-term male newborn presents with respiratory distress soon after delivery.

Soon after delivery, the neonate developed shallow breathing and increased work of breathing, for which high-flow nasal cannula was initiated at 3 L/min with fraction of inspired oxygen (Fio2) of 0.21. Empiric treatment with ampicillin and gentamicin was started for clinical pneumonia.

Chest radiography showed fracture of the left rib and slender “gracile” appearance of ribs. There was no lung opacity, pneumothorax, or pleural effusion (Fig 2).

Skeletal survey showed minimally displaced distal right clavicle fracture, transverse fracture of the right radius and ulna, transverse fracture of the left radius, mild displaced segmental fracture of the left ninth rib, angulated fractures involving the distal tibias and fibulas, and coxa varus deformity of the left femur. There was diffuse osteopenia and thin cortices of the long bones and ribs. No wormian bones in the skull,...

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