A 1-day-old girl is seen for routine care in the newborn nursery. The patient was born at 40 weeks and 1 day of gestation to a 21-year-old gravida 2 now para 2 mother by vaginal delivery. Pregnancy was complicated by maternal obesity, mild intermittent asthma, hyperthyroidism, allergic rhinitis, anemia, and sickle cell trait. The patient’s mother had adequate prenatal care and a normal prenatal anatomic ultrasonographic image. The mother’s medications during pregnancy included prenatal vitamins, ferrous sulfate, fluticasone nasal spray, and albuterol inhaler as needed. The patient’s newborn course has been uneventful. She has been breastfeeding without difficulty and is voiding and stooling normally. There are no parental concerns.

On examination the infant is well appearing and shows no dysmorphic facial features. Her temperature is 98.1°F (36.7°C), heart rate is 128 beats/min, and respiratory rate is 48 breaths/min. Her head is normocephalic, with a flat, open, and soft anterior fontanelle....

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