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Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 26A0 Case 26 History
Case 26 History ---- The patient was a 610 gm infant born on 7/7 at 24 1/2 week EGA to a 29 year old G3P0 SAB1 IAB1 mother. The pregnancy was complicated by chronic maternal hypertension treated with Aldomet, preterm labor and premature rupture of membranes, maternal pulmonary edema and hypoxemia, history of non-functional left maternal kidney (normal BUN and creatine), and history of ethanol and tobacco use. However, she received regular prenatal care starting at 6 weeks. She was admitted to an OSH and failed tocolytic treatment. The infant was born via spontaneous vaginal delivery with Apgars of 1 at 1 minute, 4 at 5 minutes, and 6 at 10 minutes. He was immediately intubated in the delivery room with an arterial blood gas of 7.11/65/39. An initial chest X-ray demonstrated mild haziness consistent with hyaline membrane disease. The infant was transferred to SLCH on 7/8 and received surfactant x2. On day of life #2 head ultrasound revealed grade IV intraventricular/intraparenchymal hemorrhage. Considering the poor respiratory status and severe CNS pathology the infant was placed on DNR status on7/9. On 7/10, the CNS lesions had progressed with severe right-sided intraparenchymal/intraventricular hemorrhage and increased left ventricular dilatation. On 7/11 the family requested withdrawal of therapy. The infant was extubated and expired on 7/11. ---- At autopsy the unfixed brain weighed 106.8 gm (normal for 24 week gestation = 83 + 15 gm) The CNS lesions were extensive and involved the right frontal parietal lobes. Hemorrhage was also apparent in the midbrain and pons. It was not possible to determine with certainty whether the latter was a discrete hemorrhage or an extension of the supratentorial bleeding.
