North American Registry of Midwives (NARM) Practice Exam

How many minor malformations in a newborn suggest the possibility of a major underlying malformation?

1. One

2. Two

3. Three

4. Four

The correct answer is: Three

The correct answer is three minor malformations in a newborn, indicating a potential underlying major malformation. This guideline stems from observational studies in pediatric medicine, where the occurrence of multiple minor anomalies can raise concern for a more significant anatomical or physiological defect. When a newborn presents with one minor malformation, it may occur as an isolated finding without suggesting any major issues. Similarly, two minor malformations, while possibly indicative of a syndrome, do not raise enough concern to strongly suggest a major malformation. However, the presence of three or more minor malformations significantly elevates the suspicion for a major underlying malformation or a syndrome that may encompass these anomalies. This is because certain structural defects and syndromic presentations often manifest through combinations of minor anomalies, and their cumulative presence can provide critical clues in the diagnostic process. Therefore, a thorough evaluation is warranted when three or more minor anomalies are noted, increasing the likelihood that they are part of a larger, more complex condition.