A girl who was the product of a 3 7-week gestation was born to a 17-year-old girl in her first pregnancy who had a history of asthma, genital herpes, third trimester Chlamydia trachomatis infection, first trimester alcohol use, and marijuana and cigarette use throughout pregnancy. The pregnancy was otherwise uncomplicated and the delivery was vaginal. No herpetic lesions were noted prior to delivery. The infant's growth parameters indicated a small for gestational age neonate with a birth weight of 2159 g (<5th percentile), length of 46 cm (10th percentile), and head circumference of 30.5 cm (<5th percentile). Results of fetal ultrasonographic scans were reported as normal. Apgar scores were 9 at 1 and 5 minutes (−1 for color).
The infant was observed to have mildly dysmorphic features that included facial asymmetry, an upturned left ear, redundancy of neck skin, and a hypoplastic left thumb. A septic workup was performed, including