LAUSR

A male infant is born at an estimated 27+3/7 weeks’ gestation via emergent cesarean delivery due to vaginal bleeding and fetal distress. The mother is a 31-year-old gravida 8, para 1-2-4-3 woman with pregnancy complications including absence of prenatal care, premature rupture of membranes, vaginal bleeding, and premature labor. She reports to our hospital on the morning of birth with preterm labor and vaginal bleeding. She receives 1 dose of steroids, magnesium, and antibiotics (ampicillin and azithromycin). Ultrasonography on the day of birth shows left ventriculomegaly, echogenic bowel, and shortened long bones suggestive of skeletal dysplasia. The infant is apneic on presentation and severely edematous. He requires extensive resuscitation including intubation, emergent UV line placement as well as thoracentesis and abdominal paracentesis because of persistently low oxygen saturations. On admission, examination reveals generalized edema, widely split cranial sutures, and grossly distended abdomen. Laboratory findings on admission reveal metabolic acidosis, low normal hemoglobin (11.5 g/dL [115 g/L]), alanine aminotransferase of 473 U/L (7.9 μkat/L), aspartate aminotransferase of 2,837 U/L (47.3 μkat/L), total bilirubin of 12.3 mg/dL (210.3 μmol/L), direct bilirubin of 4.7 mg/dL (80.4 μmol/L), and an albumin …