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A 4-Hour-Old Infant Is Evaluated in the Neonatal Intensive Care

question 590

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A 4-hour-old infant is evaluated in the neonatal intensive care unit. The infant was born at 37 weeks gestation via cesarean delivery to a healthy 33-year-old primigravid woman. Apgar scores were 6 and 8, at 1 and 5 minutes, respectively. The delivery was complicated by arrest of descent and nonreassuring fetal heart rate. The mother's laboratory testing from the first prenatal visit demonstrated negative IgG titers to rubella but was otherwise normal. Fetal anatomy ultrasound at 20 weeks gestation showed no abnormalities. The mother traveled to South America at 15 weeks gestation for a family emergency and returned 2 weeks later. She smoked half a pack of cigarettes a day throughout the pregnancy but did not use alcohol or illicit drugs. She declined influenza and tetanus-diphtheria-acellular pertussis vaccines during pregnancy. The infant's vital signs are normal. Height and weight are at the 20th percentile; head circumference is at the 95th percentile. Cardiac examination reveals a normal rate and regular rhythm. Abdominal examination reveals hepatomegaly but no other palpable masses. A head CT scan reveals hydrocephalus and diffuse intracranial calcifications. Which of the following best explains this infant's examination findings?

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