A Cystic Mass with a Twist
A 6-hours-old female infant born at gestational age 39w1d is referred to the Level 3 neonatal unit for ongoing respiratory support. She was born via a lower segment caesarean-section delivery to a G5 P2022 29-year-old with good prenatal care and two prior C-sections.
Baby’s birth weight is 2,696 grams, and her Apgar score is 8 at 1 minute and 9 at 5 minutes. Screening labs were unremarkable. Mom is O positive. Baby is O negative and Coombs negative. There was meconium-stained liquor but no maternal fever or prolonged rupture of membranes. Infant had retractions, grunting, and nasal flaring soon after birth. Respiratory distress improved with NIPPV rate 20, pressures 20/6, FiO2 40%.
Of note, prenatal ultrasound at 28 weeks showed a possible 5.6-cm complex solid and cystic mass in the right side of the abdomen and pelvis.
- General Appearance: Healthy-appearing, vigorous infant; strong cry, well-perfused
- Head: Sutures mobile, fontanelles normal size
- Eyes: Sclerae white, pupils equal and reactive, red reflex normal bilaterally
- Throat: Lips, tongue, and mucosa are moist, pink, and intact; palate intact
- Neck: Supple, symmetrical
- Chest: Lungs clear to auscultation, respirations unlabored
- Heart: Regular rate and rhythm, S1 S2, no murmurs, rubs, or gallops
- Abdomen: Soft, nontender, no masses; umbilical stump clean and dry; no abdominal mass felt
- POC Glucose: 59; 40–125 mg/DL
- Hematocrit: 61 (H); 36%–48%
- Hemoglobin: 20.7 (HH); 12.0–16.0 g/dL
- pH Cap: 7.38; 3.30–7.45
- pCO2, Cap: 39.2; 35–45 mmHg
What is the next best step in management?
Tanya Brown, MD, Pamela Botchway, MD, and Jacek Ubaka, MD
Department of Neonatology
John H. Stroger Hospital of Cook County
- Categories: Case Quiz