A term male infant born at an outlying hospital to nonconsanguineous parents was transferred immediately after birth due to facial dysmorphisms and limb abnormalities (Figs 1A, 1B, 1C).

  • Born to a 24-year-old gravida 1, para 0 white woman.

  • Pregnancy complicated by mild oligohydramnios at 36 weeks’ gestation that resolved with hydration; prenatal ultrasonography findings unremarkable with consistent fetal movement throughout pregnancy

  • Cesarean section at 38 weeks’ gestation for breech presentation

  • Prenatal maternal laboratory findings: Group B Streptococcus negative, hepatitis B surface antigen negative, rubella immune, HIV negative, rapid plasma reagin nonreactive

  • Apgar scores: 4 and 9 at 1 and 5 minutes, respectively

The infant was cyanotic and hypotonic at birth with no respiratory effort. He required positive pressure ventilation for approximately 2 min and was then transitioned to nasal cannula oxygen. His tone improved by 5 minutes of age. He was transported to a level 3...

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