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Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 5A0 Case 5 History
Case 5 History ---- The patient was a 58-day-old male infant born at 22-week EGA as a twin B from a G4P4 mother who presented three weeks prior to twin B delivery with fetal demise of twin A. Twin B was delivered vaginally and with Apgar scores of 4 and 8 at one and five minutes, respectively. His NICU course was complicated by severe chronic lung disease, necrotizing enterocolitis s/p small bowel resection and end jejunostomy, hypotension requiring pressors; anemia, hypernatremia and hyperglycemia secondary to prematurity. Additionally, biochemical rickets, neonatal hyperbilirubinemia, tracheitis status post treatment, large patent ductus arteriosus status post PDA ligation, and right pneumothorax status post needle decompression continued his litany of problems. He developed a bilateral grade 1 intraventricular hemorrhage and underwent exploratory laparotomy to resect a necrotic bowel segment due to necrotizing enterocolitis. Following closure of the surgical site, the patient experienced decompensated distributive shock resistant to fluids, blood products, and pressor support. Later that day he was removed from his ventilator circuit and administered positive pressure ventilation, increased pressor support, and fluids. His heart rate dropped to below 60, and chest compressions were started and continued through the entirety of the code. He expired at 8 weeks of age. ---- At autopsy the weight of the unfixed brain was 180 gm (normal, 135 +/- 24g). Multiple bilateral, focal and microscopic hemorrhages involved the, subependymal germinal matrix, and resulted in granular ependymitis involving the left lateral ventricle.
