A female infant who was small for her gestational age (weight, 1118 g) was born at 32 weeks' gestation to a 27-year-old, gravida 4, para 2-3 woman. Her parents were not blood relatives. Intrauterine growth retardation and spontaneous rupture of the membranes with preterm labor had complicated the pregnancy. Dysmorphic features, tight skin, poor respiration, and a low heart rate were reported at delivery. Two male siblings were alive and well. No family history of genetic abnormalities was reported, except for a second cousin with Down syndrome. Chromosomal studies of a bone marrow aspirate demonstrated a normal 46 XX karyotype.