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Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 7A0 Case 7 History
Case 7 History ---- The patient was a 30 day old male twin born prematurely due to preterm labor via cesarean section at 24 weeks of gestational age to a G5P6, 32 year old. During delivery the patient was breech position with a very weak cry. His Apgar scores were 5 and 7 at 1 and 5 minutes. Due to his lung immaturity, the patient was placed on ventilator support and transferred to SLCH NICU. The patient had a very complicated hospital course that included respiratory distress syndrome with pulmonary hemorrhage, diabetes insipidus and renal insufficiency. The patient had cerebellar hemorrhage, bilateral thalamic hemorrhages, periventricular white matter disease (leukomalacia), and Grade III/IV bilateral interventricular hemorrhage with dilation of lateral, 3rd, and 4th ventricles. The patient developed seizures. On July 20, exams showed post-hemorrhagic hydrocephalus and a frontal McComb reservoir was placed in the left lateral ventricle. During the hospital course the patient was also extubated unsuccessfully necessitating re-intubation due to his acute apneic episodes. Around July 25 the patient started receiving enteral feedings of donor breast milk while still on TPN. The doctors advanced his feedings slowly due to their concern of developing necrotizing enterocolitis. Early in the morning of August 3, 2012 the patient began developing feeding intolerance. Serial x-rays were done with the last one at 3 pm showing a pneumoperitoneum with large volume of free air over the liver and a large loculated pneumoperitoneum in the right lower quadrant, consistent with intestinal perforation. After discussing the findings with the family, care was redirected and the patient expired. ---- At autopsy the weight of the unfixed brain was 110 gm (normal =132 +/-29 gm). The autopsy examination showed a premature infant brain with severe recent infarct involving most of the right middle cerebral artery as well as the periventricular white matter and cerebellum, severe global ischemic damages, as well as multifocal, extensive subependymal SEGM and intraventricular hemorrhages, which resulted in granular ependymitis.
