Neonate Presenting with a Midline Supraumbilical Raphe
A newborn female (2.07 kg, 45.5 cm), who was born at 32 weeks gestation via an uncomplicated vaginal delivery, presented at birth with hypoglycemia and a midline sternal defect. Physical examination revealed an 8-cm supraumbilical linear defect (Fig. 1) with surrounding welldemarcated patchy areas of hypopigmentation on the central chest, chin, and lower lip and focal deeply erythematous macules on the nasal columella and left malar cheek. The neonate received phototherapy for hyperbilirubinemia and empiric antibiotics for presumed sepsis due to the exposed tissue from the sternal defect; however, her blood cultures remained negative. Thoracic ultrasonography showed no evidence of ectopia cordis. An echocardiogram revealed a patent foramen ovale with a small patent ductus arteriosus without other defects, and an EKG showed normal sinus rhythm. Over several days of life, she progressively developed prominent and widespread plaque-like facial hemangiomas along the jawline and bilateral malar cheeks, as well as on the left temporal scalp, periocular, and nasal regions (Figs. 2 and 3).