A Term Newborn Is Undergoing Routine Evaluation in the Nursery

A term newborn is undergoing routine evaluation in the nursery.  The boy was born 12 hours ago via spontaneous vaginal delivery to a 24-year-old woman.  His mother had appropriate prenatal care, and her pregnancy was uncomplicated.  Delivery was unremarkable, and the patient has had a normal nursery course.  He received the hepatitis B vaccine, erythromycin eye ointment, and intramuscular vitamin K after delivery.  Family history reveals factor VIII deficiency in the patient's paternal grandfather.  Vital signs are normal.  Physical examination shows a sleeping newborn with normal tone.  A 1/6 systolic murmur is best heard at the left sternal border.  Peripheral pulses are strong.  Genitourinary examination shows a penis of normal length with no curvature.  The urethral meatus extends to the corona on the ventral aspect of the penis, and the foreskin has a dorsal hood appearance.  The testes are present bilaterally within the scrotum.  The patient urinates through the urethral meatus during examination.  The father requests that a circumcision be performed.  Which of the following is the best next step in management of this patient?

A) Coagulation studies
B) Echocardiogram
C) Karyotype
D) Renal ultrasound
E) Urology evaluation

Correct Answer:

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