A 3120-g, full-term female newborn was born to a 31-year-old mother following an uncomplicated pregnancy, labor, and delivery. The newborn's initial Apgar scores were 4 and 6 at one and five minutes, respectively, and she had mild respiratory distress and transient hypoglycemia. These problems resolved in approximately two hours, and medically the neonate seemed normal enough to receive her first oral feeding after 12 hours of age. At 20 hours of age, she suddenly became hypotensive and cyanotic, while abdominal distention and profound shock rapidly followed. A sepsis workup was begun and an abdominal roentgenogram (Figure) was obtained. Hypotension persisted despite aggressive medical management, and emergency laparotomy became necessary. Thirty-six hours later the newborn died. An autopsy limited to the chest and abdomen ensued.
Denouement and Discussion
Necrotizing Enterocolitis and Congenital Adrenal Hypoplasia
Abdominal roentgenogram demonstrates distention of bowel loops. Intramural gas extends throughout small bowel, large bowel, and