How Would You Diagnose This Neonate’s Abnormal Head Shape?

AUTHORS:
Melissa N. Rodriguez, MD¹ • Allison C. Heinly, MD^2,3 • Chandan N. Lakhiani, MD^2,4

AFFILIATIONS:
¹Resident Physician, Pediatrics Department, The Warren Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
²Pediatrician, Hasbro Children’s Hospital, Providence, Rhode Island
³Assistant Professor of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
⁴Director of Residency Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island

CITATION:
Rodriguez MN, Heinly AC, Lakhiani CN. How would you diagnose this neonate’s abnormal head shape? Consultant. 2022;62(6);e10-e13. doi:10.25270/con.2021.08.00012

Received January 26, 2021. Accepted March 30, 2021. Published online August 26, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Melissa N. Rodriguez, MD, Hasbro Children’s Hospital, 2 Dudley Street, #190, Providence, RI 02905 (melissa.rodriguez18@upr.edu)

A 4-day-old boy born at 38 weeks’ gestation presented with his parents to our pediatric outpatient clinic for his first newborn visit. His mother is a 26-year-old G8P4 woman.

The boy’s prenatal history is pertinent for routine prenatal care; his mother had taken only prenatal vitamins and an antihistamine during her pregnancy. A level II ultrasonography scan conducted during the pregnancy showed a normal fetal anatomic survey. There was no oligohydramnios during the pregnancy.

The boy was born via a spontaneous vaginal delivery without any complications. His Apgar scores were within normal limits at 8 at 1 minute and 9 at 5 minutes. His newborn nursery course was uncomplicated.

A physical examination conducted at the time of discharge documented the presence of frontal bossing and hypospadias of the penis. The baby was discharged home on day of life 2.

Physical examination. During the current visit, the physical examination was significant for an atraumatic head with a normal anterior fontanelle. The boy’s head circumference was in the 93rd percentile, which was unchanged from his head circumference percentile noted upon discharge from the newborn nursery. Palpation of the head revealed no hematomas. The forehead appeared narrow with a palpable midline ridge.

A cranial ultrasonography scan was conducted, results of which showed calvarial sutures that were patent without craniosynostosis. In discussion with the parents, the decision was made to monitor the boy’s head and reassess at the next visit.

At the second outpatient visit 1 month later, the boy was 5 weeks old and continued to have a prominent palpable midline ridge, as well as hypospadias (Figures 1 and 2). A new umbilical hernia was also diagnosed.

Figure 1. The 5-week-old boy had a prominent palpable midline ridge.

Figure 2. The 5-week-old boy had a prominent palpable midline ridge.

Answer and discussion on next page.