CLINICAL HISTORY.—A 12-hour-old girl was admitted to the Pediatric Department of the Hospital of the University of Pennsylvania with multiple congenital anomalies. The mother's pregnancy was complicated by moderate hydramnios but delivery was a normal spontaneous vaginal one. The infant was apneic at birth and was resuscitated.
On physical examination, she was found to have oxycephaly, widening of the sagittal suture, suspected premature synostosis of the coronal and lambdoidal sutures, and cleft palate. Exophthalmos was present. Although the nasal passages were patent to a catheter, the bridge of the nose was sunken. The ears assumed a low position on the head. Marked cyanosis which worsened on crying was noted. The heart rate varied from 140 to 150 beats per minute and a grade III-IV systolic murmur was heard over the entire precordium. Syndactylism of all four extremities was present.
The hospital course was progressively downhill due to congestive heart