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Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 13A0 Case 13 History
Case 13 History ---- This patient, a male twin B, was the 830-gram product of a 26 week gestation. Pregnancy was complicated by group B strep pyuria diagnosed on 04/27 which was likely untreated, history of chlamydia which was treated in March 2011 and severe preeclampsia. Mom presented with headache, abdominal pain and visual changes followed by several seizures. Baby B's heart rate was 50-60s just prior to delivery and he was born limp and cyanotic. He required chest compressions for 2-4 minutes with positive pressure ventilation. Surfactant replacement therapy was given. Apgars were 1, 3, and 8 at 1,5,10 minutes. Empiric antibiotic therapy, TPN and intravenous fluids were begun. A head ultrasound initially showed no abnormalities on 5/6. Hemoglobin dropped to 6.5 from 13.5. He was placed back on the ventilator and his saturations started to decline to the 20s and his heart rate also began to fall. The family asked that the monitors be turned off and the patient died on 5/7. ---- At autopsy the brain weighed 121 g (normal=105 + 21 g). The leptomeninges showed patchy subarachnoid hemorrhage and blood was extruding out of the foramina of Luschka. Coronal sections of the cerebrum show intraventricular and intra-parenchymal hemorrhage predominantly involving the right side (Grade IV). Sections of the right cerebrum show multiple foci of germinal matrix with hemorrhage and intraparenchymal hemorrhage. The fourth ventricle is dilated by blood.
