The VACTERL association consists of a spectrum of defects including vertebral, cardiac, renal, and limb anomalies, anal atresia, and tracheoesophageal fistula. This association was detected in a 33-week preterm female twin newborn (1300 g) with findings of anal atresia, rib anomaly, ventricular septal defect, renal anomaly, and extremity anomaly. No etiologic factor was elicited. Colostomy was performed on the first postnatal day. In the postoperative period, she developed atelectasis and required mechanical ventilation. She died on the 44th postnatal day due to pulmonary hemorrhage.