Review Question - QID 109349

A newborn girl is evaluated in the hospital nursery 1 hour after birth. She was born at 39 weeks of gestation to a 34-year-old gravida 3 mother via vaginal delivery. The pregnancy was notable for a 1st trimester ultrasound demonstrating a single fluid-filled structure in the nuchal region with distended jugular lymph sacs. The patient’s parents declined further testing. Upon delivery, the patient had a strong respiratory effort with good muscle tone. Her Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Her weight is 3120 g (6 lb 14 oz), and her height and head circumference are in the 10th and 20th percentiles, respectively. The patient’s temperature is 97.4°F (36.3°C), blood pressure is 61/43 mmHg, pulse is 146/min, and respirations are 40/min. On physical exam, the patient has the finding seen in Figure A. Which of the following is the most likely etiology of this patient’s presentation?