A 25+3 week gestation male infant weighing 493 g was delivered via caesarean section for intrauterine growth restriction and abnormal Dopplers. The mother was on long-term thromboprophylactic warfarin 5 mg/day due to her prosthetic mechanical heart valve following childhood rheumatic fever. Once pregnancy was diagnosed, at 4+0 weeks’ gestation, warfarin was discontinued and low-molecular-weight heparin was started. Warfarin was recommenced at 12+1 weeks’ gestation after a small maternal stroke.

Neonatal dysmorphic facial features …