A neonate with calcifications in antenatal and postnatal ultrasound scans: A neonatologist’s perspective

A 20-year-old primigravida delivered a female neonate vaginally at 38 weeks of gestation. Antenatal ultrasound at 29 weeks found fetal ascites. A repeat scan at 32 weeks showed resolution of ascites with calcification seen on the visceral peritoneum liver and spleen.

Anthropometry at birth: Head circumference was 31.5 cm (−2 standard deviation [SD] to −3SD), birth weight was 2550 g (0 to −2SD), and length was 48 cm (0 to −2SD) as per the World Health Organization growth charts. The rest of the examination was normal. Postnatal X-ray showed fleets of intra-abdominal calcification [Figure 1]. Abdominal and periventricular calcification were seen on ultrasound [Figure 2]. Work-up including complete blood count, calcium, polymerase chain reaction for cytomegalovirus (CMV), and toxoplasmosis and clinical exome study were negative.

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Figure 1:

Fleets of intra-abdominal calcification (white arrow) on postnatal day 1.

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Figure 2:

Ultrasound images demonstrating calcification (white arrows). (a) Periventricular calcification with multiple calcifications along the vessels within the thalami, (b) renal calcifications, and (c) hepatic calcifications on postnatal day 2.

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Important differentials include congenital infections: CMV, toxoplasmosis, and genetic disorders associated with hypercalcemia. Short-term outcomes are favorable as seen in the current case.^[1] In neonates requiring surgery, a postoperative mortality rate of 8.1% has been reported.^[2]