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Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 3A0 Case 3 History
Case 3 History ---- The decedent is a one day old baby boy born at 37 weeks gestation via vaginal delivery to a 23 year old G2P1 A-/rubella immune/RPR nonreactive/hep B antigen negative/HIV negative mother. The baby was born with a heart rate of 70 and no respiratory effort. The mother received regular prenatal care since first trimester, and during the 20 week anatomic screening ultrasound, multiple congenital anomalies were found including cystic dysplastic kidneys, bladder outlet obstruction, anhydramnios, double outlet right ventricle, unbalanced AV canal, and anomalous pulmonary venous return as well as the stigmata of trisomy 18. ---- After birth a chest X-ray showed cardiomegaly, severe pulmonary hypoplasia, ultrasound evidence of echogenic dysplastic kidneys, severe hydronephrosis and dilated ureters with collapsed bladder. Head ultrasound showed diffusely echogenic parenchyma thought to represent white matter disease. Due to the severity of pulmonary hypoplasia and kidney dysplasia, and family redirected care to comfort measures and the infant died within the first day of life. ---- At autopsy sections of the basal ganglia and occipital lobe visual cortex showed germinal matrix hemorrhages, a hypoplastic left hemi-cerebellum with subpial cerebellar hemorrhages. The more chronic lesions found in this infant establish this lesion as intrauterine in origin.
