A 24-year-old pregnant woman with premature rupture of membrane and labour pain was admitted to the Maternity ward of Al-Hadi Hospital in Shoushtar, Iran, on 26 October 2018, at 3:30 a.m. for her third pregnancy. The gestational age based on the first day of the last menstrual period (LMP) was 36 weeks and 2 days, and based on sonography was 36 weeks and 5 days. Sonography at 9 weeks and 4 days and at 25 weeks and 3 days of gestation found no abnormalities in foetal development. No prenatal genetic investigation and eventual genotypic characterization were carried out for the baby. In the 36th week of gestation (27 October 2018, at 11:50 a.m.), a live male infant was delivered via caesarean section due to a slow foetal heartbeat and continued labour pain. The baby was diagnosed with HI. His birthweight, length and head circumference was 2.700 kg, 42 cm and 36 cm with Apgar 8, respectively. Apgar's score in the 5th minute was measured as 10. The baby had ichthyosis of the scalp, face and neck with outward pouting of lips or fish mouth, compressed ear pinna and open eyes because of the outward turning of eyelids from the eyeball. The head was characterized by a scalp with partial hair loss (alopecia) (Figure 1). The newborn at birth was not evaluated for markers of inflammation, electrolytes and so on. The baby was sent to the neonatal intensive care unit (NICU) upon delivery. The nurses tried several times to get an intravenous line (IV) from the neonate, but they failed. Hence, 2 days later, the baby was transferred to the neonatal unit. According to the physician's recommendation, no antibiotics were administrated. The skin management included eye softeners, saline compresses and gentle emollients. However, he died on the 5th day.
The parents had a distant relationship and had no similar condition of HI in the previous pregnancy or family history. They had a healthy child. In her second pregnancy, she had delivered a stillborn male infant at 38 weeks' gestation due to diminished foetal movement and delay in reaching a hospital.