The infant or young child presenting
with deep skin creases should be investigated for associated anomalies. A full
history and physical examination must be done to assess for cleft palate,
congenital heart disease, and craniofacial abnormalities. Developmental
delay may be present. Investigations should include hemoglobin level,
electrocardiogram, chest radiograph, and echocardiogram if necessary. Workup
for neuroblastoma would include urine and plasma catecholamine levels and
imaging studies. Uncommonly, hypertension is present, which should be well
controlled prior to anesthesia.