**Question:** Baby born at 30 weeks for 18 year old primi gravida of weight 2 kg which died after 48 hours. Apgar scores were 5 and 8 at 1 and 5 minutes. On autopsy bilateral enlarged kidney with multiple radially arranged cysts. Which of the following finding is expected to be associated with?

A. Congenital malformations
B. Neonatal sepsis
C. Hypoxic ischemic encephalopathy
D. Congenital anomalies of the kidney and urinary tract (CAKUT)

**Core Concept:** Congenital anomalies of the kidney and urinary tract (CAKUT) is a group of disorders that affect the development of the kidney and urinary system during fetal life. They can lead to various abnormalities in kidney size, shape, or function. In this case, the finding of bilateral enlarged kidneys with multiple radially arranged cysts is consistent with CAKUT.

**Why the Correct Answer is Right:** The correct answer is D (Congenital anomalies of the kidney and urinary tract, CAKUT), as the described autopsy findings are indicative of kidney malformations. The bilateral enlarged kidneys with multiple radially arranged cysts suggest cystic renal dysplasia, which is a type of CAKUT. These abnormalities can lead to impaired kidney function and ultimately contribute to the baby's early death.

**Why Each Wrong Option is Incorrect:**

A. Congenital malformations (Congenital malformations is too broad and does not specifically address the described autopsy findings. It does not specify the type of malformation or its relation to the baby's death.)

B. Neonatal sepsis (Neonatal sepsis refers to infection in neonates and is not directly related to the described autopsy findings.)

C. Hypoxic ischemic encephalopathy (Hypoxic ischemic encephalopathy is a brain disorder resulting from insufficient oxygen and blood supply to the brain, not related to the described autopsy findings.)

**Clinical Pearl:** CAKUT is a group of disorders that should be considered in cases of prematurity, low birth weight, and early neonatal death, as it can lead to renal dysfunction and other complications. Early diagnosis and management of these anomalies can improve outcomes in such cases.