A Neonate with Deformities of the Bilateral Lower Extremities and Bowel and Urinary Incontinence.

Abstract

G13P8 woman with a history of insulin-dependent diabetes who had no prenatal care. Apgar scores at birth were 8 at 1 minute and 9 at 5 minutes, and he weighed 3,130 g (90th percentile for gestational age). The neonatologist was consulted soon after birth due to the child’s respiratory distress. On physical examination, he was crying and vigorous with normal heart rate and rhythm, and no murmur. He had a three-vessel umbilical cord and normal bilateral upper extremities. No movements were visible on the lower extremities. He had bilateral hip abduction, his ankles showed equinovarus deformity, and he had fixed bilateral knee extension (Figure 1). Passive movements were extremely limited, but his pain sensation was intact. His spine appeared to be straight, with flattening of the gluteal region. A laboratory test on admission for methamphetamine was positive for both the mother and infant. The mother’s hemoglobin A1C was 8.5%. The patient was placed on nasal continuous positive airway pressure for respiratory support. He had persistent hypoglycemia requiring high dextrose, calcium, and steroid infusion. He was also noted to have incontinence of his bowel and urinary system with skin excoriation. Imaging studies were obtained and confirmed the diagnosis