Review Question - QID 109347

A newborn boy is evaluated 30 minutes after birth. He was born at 38 weeks gestation to a 39-year-old gravida 3 mother via vaginal delivery. The pregnancy was complicated by gestational diabetes and the patient’s mother received routine prenatal care. The family declined all prenatal testing including an anatomy ultrasound. The patient’s 2 older siblings are healthy. Upon delivery, the patient appeared well and had good respiratory effort. He was noted to have acrocyanosis and his Apgar scores were 8 and 9 at 1 and 5 minutes of life, respectively. The patient’s birth weight is 3840 g (8 lb 7 oz). His temperature is 98.7°F (37.1°C), blood pressure is 66/37 mmHg, pulse is 142/min, and respirations are 34/min. On physical exam, the patient has low-set ears, upslanting palpebral fissures, and a hypoplastic 5th digit on his hands bilaterally. Which of the following additional findings is most likely to be seen in this patient?