RT Journal
A1 Shastri N
T1 PIcture of the month—quiz case
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2007
FD July 1
VO 161
IS 7
SP 711
OP 711
DO 10.1001/archpedi.161.7.711
UL http://dx.doi.org/10.1001/archpedi.161.7.711
AB 
A term baby was born by spontaneous vaginal delivery to a gravida 5, para 5 mother. His Apgar score was 7 after 1 minute. At 5 minutes, the score was 8 because of the presence of acrocyanosis and low heart rate. He was appropriate for gestational age with a birth weight of 3417 g, length of 51.7 cm, and head circumference of 35.5 cm. On examination, there was a bifid thumb with duplication of the distal phalanx on the right hand (Figure 1). On auscultation, an ejection systolic murmur grade 2/6 on the left sternal border was heard. Electrocardiography showed bradycardia with a heart rate of 93 beats/min. Echocardiography revealed a secundum atrial septal defect measuring 1.33 cm (Figure 2). There was no family history of any limb or heart defects.