A small-for–gestational age term female neonate born at 38 weeks and 4 days of gestation is transferred to a level 4 NICU at 11 days of age for further evaluation and treatment of bilateral parenchymal brain hemorrhages, culture-negative meningitis, history of thrombocytopenia, coagulopathy, and transaminase elevation. The infant was born via cesarean section to a 31-year-old gravida 2, para 2-0-0-2 healthy mother due to decreased fetal movement and non-reassuring fetal heart tones. The pregnancy was complicated by gestational hypertension and suspected fetal 47,XXX chromosomes. Maternal medications during pregnancy included prenatal vitamins. Maternal prenatal infection screening results were unremarkable. Membranes ruptured at the time of delivery with thick meconium. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The infant’s birthweight was 2,419 g.

Physical examination on admission shows her weight to be 2,580 g (1.33 percentile). She is active and not ill-appearing, with a respiratory rate of...

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