A Term Newborn Is Evaluated in the Nursery 1 Hour

A term newborn is evaluated in the nursery 1 hour after a spontaneous vaginal delivery to a 28-year-old primigravida whose pregnancy was uneventful.  The patient's Apgar scores were 9 and 9 at 1 and 5 minutes, respectively.  Vital signs are normal.  Physical examination shows a newborn sleeping comfortably with overlapping coronal sutures.  There is a I/VI systolic murmur at the left upper sternal border that radiates to the axilla.  The lungs are clear bilaterally.  The abdomen is soft, and the liver is palpable 2 cm below the costal margin.  Genitourinary examination shows curvature of an underdeveloped penis.  The urethral meatus is at the ventral surface of the base and flanked by the surrounding scrotal sac.  Gonads are not palpable.  Examination of the back shows a sacral dimple with intact skin.  The patient has normal fingers and toes.  There is cyanosis in the digits.  There is symmetric movement of all 4 extremities, and Moro and suck reflexes are normal.  Which of the following is the best next step in evaluation of this patient?

A) Echocardiogram
B) Head ultrasound
C) Karyotype analysis
D) Liver ultrasound
E) Serum alpha-fetoprotein

Correct Answer:

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