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.