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Washington University Experience | PERIPHERAL NEUROPATHY | 1 NORMAL NERVE ANATOMY | 6 Infant Peripheral Nerve | 6A0 Case 6 History
Case 6 History (9 wk effective age) ---- The decedent was a 5-month-old female infant with history of prematurity (born at 29 weeks gestational age), and moderate to large ventricular septal defect (VSD) and atrial septal defect (ASD) with branch pulmonary stenosis. She was hospitalized in the NICU until 3 months of life. During that time, she developed hemorrhage in the cerebellum and right occipital lobe. Due to her chronic lung disease requiring oxygen, she underwent surgical closure of her ASD and VSD on 6/15. Intraoperative course was uncomplicated with exception of brief period of complete heart block as she was separated from cardiopulmonary bypass. On 6/16 she developed bradycardia, which quickly escalated to pulseless electrical activity. CPR was initiated. Her median sternotomy incision was reopened and a large amount of dark blood was evacuated from the chest. The heart showed no mechanical activity and internal compressions were resumed. Rapid inspection within the mediastinum revealed a disrupted suture at the left superior vena cava, which was repaired. There was clearly an inadequate blood pressure and overall inadequate perfusion being achieved. The pulmonary artery was quite tense consistent with severe pulmonary vasospasm. She was placed on VA-ECMO cannulation. On the evening of 6/17, she developed subclinical seizures. A head CT showed a global hypoxic ischemic injury. On 6/18, she had no lower extremity pulses. Abdominal CTA revealed an occlusive thrombus in the descending aorta. Her parents elected to redirect her care to comfort measures. She died at a total effective age of approximately 8wk.
