An 18-Hour-Old Girl Is Undergoing a Routine Examination in the Newborn

question 906

Multiple Choice

An 18-hour-old girl is undergoing a routine examination in the newborn nursery.  The patient has urinated 4 times and passed meconium.  She was born via uncomplicated vaginal delivery at 41 weeks to a 23-year-old primipara.  Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.  Birth weight and length are at the 25th percentile for gestation.  Temperature is 37.2 C (99 F) .  The patient is initially asleep but easily roused.  Examination shows open and soft fontanelles, posteriorly rotated ears, and a small maxilla.  The soft palate has a high arch, but no submucosal cleft is felt on palpation.  The neck is short and webbed, without masses.  Auscultation reveals a regular heart rate and rhythm with no murmurs.  There is good air entry in all fields with no grunting, retractions, or nasal flaring.  External genitalia are normal.  The hands and feet are moderately edematous.  Crease lines on both hands are normal.  Pulses are 2+ in all extremities. The mother is concerned about the recurrence risk of this condition in subsequent pregnancies.  Which of the following is the best response?

• A)The recurrence risk is approximately 50%.
• B)The recurrence risk is close to that of the general population.
• C)The recurrence risk is close to 10%.
• D)The recurrence risk is approximately 25%.
• E)The risk increases with maternal age.

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