ABSTRACT
You are asked to perform an emergency consultation in the NICU on a 3-day-old girl born at 27 weeks of gestation, weighing 1,070 g. The patient has a complex prenatal and perinatal history. She was the recipient twin in a twin to twin transfusion syndrome. Fetoscopic laser coagulation of intertwin vessels occurred at 22 weeks of gestation. The babies were born by stat C-section due to maternal septic shock of unclear etiology. The patient had Apgar scores of 3 and 1 at 1 and 5 minutes, respectively, and was intubated at birth. A large patent ductus arteriosus (PDA) was diagnosed. Atrial flutter developed at 3 days of age after manipulation of an umbilical venous catheter. After successful cardioversion, severe abdominal distention was noted. Abdominal films were obtained and are shown in Figure 26.1, along with the appearance of the abdomen.
