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March 1994

Pathological Cases of the MonthCase 1

Arch Pediatr Adolesc Med. 1994;148(3):283-284. doi:10.1001/archpedi.1994.02170030053011

A 3.0-KG MALE infant was delivered by cesarean section after 33 weeks' gestation. He was the product of a previously uncomplicated first pregnancy to an A-positive mother of Japanese origin. On the day of delivery, the mother presented in preterm labor. Fetal ultrasound at presentation revealed polyhydramnios and fetal hydrops. There was neither maternal history of acute or chronic illness, nor serologic evidence of antibody sensitization.

At delivery, the baby was hydropic with severe respiratory distress and abdominal distension but no dysmorphic features. He underwent intubation and required significant peak pressures (>45 mm Hg) with 100% oxygen to achieve acceptable oxygen saturations. A chest and abdominal roentgenogram revealed bilateral pleural effusions with decreased lung volumes, ascites, and massive soft-tissue edema. Initial laboratory evaluation revealed a leukocyte count of 6.6×109/L, a hematocrit of 0.27, and a platelet count of 346×109/L. Leukocyte differential cell count was 0.09 neutrophils,