Case Presentation:
Our patient was born at 34 weeks gestation via a planned caesarean
section. His mother had longstanding Crohn’s disease managed with
infliximab. She was diagnosed with rectal cancer during pregnancy,
necessitating the premature delivery to facilitate maternal
chemotherapy. An antenatal ultrasound at 28 weeks’ gestation had
previously noted polyhydramnios, a two-vessel umbilical cord and a right
pelvic kidney. No resuscitation was required at birth. His birth weight
was 1,783 g (10th%ile) and head circumference 31 cm
(10-50th%ile). He was diagnosed with VACTERL
association based on clinical manifestations. The two-vessel umbilical
cord was confirmed at birth and subsequent ultrasound noted a horseshoe
kidney, with his low-lying right kidney fused to the inferior pole of
the left kidney. His family history was otherwise unremarkable, and he
had one older half-sister who was healthy.
Challenge Point: A preterm male infant has suspected VACTERL
association and is admitted to the NICU for ongoing care.