Black Eschar on a 4-day-old Preterm Infant Jennifer Murphy, MD,* Christian Con Yost, MD,* Scott Short, MD, † Mouied Alashari, MD, ‡ Belinda Chan, MD* *Division of Neonatology, Department of Pediatrics; † Division of Pediatric Surgery, Department of Surgery; ‡ Division of Pediatric Pathology, Department of Pathology, University of Utah, Salt Lake City, UT THE CASE A 4-day-old female neonate presented with a black necrotic lesion with circum- ferential ulceration and erythema located to the left of the umbilicus. Prenatal and Birth Histories • Female infant born to a 31-year-old gravida 1, para 0 woman • Maternal medications included prenatal vitamins; uncomplicated pregnancy without infections, exposures, genital lesions, smoking, alcohol, or drug use • No risk factors noted for congenital infections with normal maternal prenatal screenings • Normal fetal survey conducted via ultrasonography at 20 weeks’ gestation • Pregnancy complicated by intrauterine growth restriction and fetal distress with absent end diastolic blood flow noted before delivery • Also complicated by severe preeclampsia and mild thrombocytopenia with platelet count 134Â10 3 /mL (134Â10 9 /L) at 27 4/7 weeks’ gestation; treated with betamethasone, magnesium, labetalol, and nifedipine • Infant delivered at 27 5/7 weeks’ gestation via cesarean delivery due to fetal distress • Artificial rupture of membranes 1 minute before delivery with clear fluid; Apgar scores 3 and 9 at 1 and 5 minutes, respectively • Infant required positive pressure ventilation and intubation during resuscitation Presentation The infant was admitted to the NICU. An umbilical venous catheter (UVC) was inserted with the use of betadine as the antimicrobial skin preparation and a thin hydrocolloid dressing (DuoDERMÒ, ConvaTec, Bridgewater, NJ) as a protective skin barrier to secure the UVC. The hydrocolloid dressing was located just left of the umbilicus and placed on intact abdominal skin. The infant was noted to have asymptomatic thrombocytopenia (platelet count 73,000/mL [73Â10 9 /L]) and neutropenia (absolute neutrophil count 700/mL [0.70Â10 9 /L]), which were attributed to maternal preeclampsia. The infant received 1 dose of granulocyte colony-stimulating factor (G-CSF, 10 mg/kg, subcutaneously) at 2 days of age. Prophylactic antibiotics were not indicated at the time of birth because there were no concerns for infection. The infant underwent extubation to receive nasal noninvasive ventilation within 24 hours of birth. At 4 days of age, she developed persistent apnea and episodes of bradycardia necessitating reintubation. Chest radiography was AUTHOR DISCLOSURE Drs Murphy, Yost, Short, Alashari, and Chan have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. e564 NeoReviews Visual Diagnosis