Table of Contents
Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 12A0 Case 12 History
Case 12 History ---- The patient was a 24 week EGA born to a 28 year old G6P0Ab5 mother who survived 2 weeks. The infant was one of a triplet gestation conceived by artificial insemination. The mother experienced preterm and the infant was delivered by C-section secondary to breech presentation on 8/16. The clinical assessment was severe prematurity with hyaline membrane disease. The infant was started on Ampicillin and Gentamycin for concern of sepsis. A blood culture positive for Gram positive cocci in clusters prompted continuing antibiotics with added Vancomycin. A head ultrasound showing a newly developed posterior fossa hemorrhage without any evidence of intraventricular or intraparenchymal hemorrhage. On 8/27 a repeat head ultrasound showed a large right intraventricular hemorrhage. The clinical picture was one of overwhelming sepsis; blood culture grew Enterobacter in the blood with poor sensitivity to cefotaxime and therefore antibiotic coverage was switched to Vancomycin, Tobramycin, and Timentin. The infant had unstable hemodynamic parameters over night with decreasing blood pressure. The family decided to withdraw further support and the infant expired on 9/3. ---- At autopsy right intraventricular and periventricular subependymal hemorrhage and cerebellar hemorrhage was demonstrated. This infant's lungs showed early bronchopulmonary dysplasia and superimposed bronchopneumonia, the probable source for bacteremia.
