Table of Contents
Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 14A0 Case 14 History
Case 14 History ---- The decedent was a 0 day old male infant born at 29 weeks to a 27 year old G1P1 on 7/16. Pregnancy was complicated by a maternal UTI, a history of treated Clostridium difficile infection and preterm labor with fever (101.6oF) and fetal tachycardia (HR 195-200 bpm). A blood culture was positive for gram-positive bacilli. Persistent fever prompted C section. Meconium stained fluid was noted at delivery; Apgars were 2 at one minute and 6 at five minutes. The patient was floppy, cyanotic, and had minimal response to bag mask ventilation and chest compressions. Ampicillin was given, and surfactant was administered. Listeria monocytogenes infection was identified. At an OSH he had profound respiratory and metabolic acidosis and was transferred to SLCH. Over the next four hours the patient’s hemoglobin dropped to 7.2 g/dl and he required packed red blood cells, fresh frozen plasma, and platelets, as well as increasing doses of dopamine, dobutamine, and epinephrine. Head ultrasound was performed which showed severe grade III bilateral SEGM hemorrhages. Bradycardia developed and chest compressions were performed while the patient was baptized and then the patient was extubated. ---- The brain weighed 205 g (nl = 166 + 25g). The brain is sectioned to show clotted blood filling nearly the entire ventricular system. Serial coronal sections of the cerebral hemispheres show dusky appearing peri-ventricular white matter without obvious hemorrhage. Sections of the cerebellum and brainstem show mass effect secondary to blood clot filling and expanding the fourth ventricle. Sections of the diencephalon show micro-hemorrhage within the developing germinal matrix. The leptomeninges are highly vascular consistent with developmental age. Paraventricular white matter shows gliosis and some nuclear crumbs.
