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Washington University Experience | VASCULAR | Hydrocephalus, Post-Hemorrhagic | 7A0 Case 7 History
Case 7 History ---- This female neonate was born at an outside hospital at 24 weeks gestation to a 17 year old mother. The pregnancy was complicated by chlamydia vaginal infection, tobacco and marijuana use. The patient's mother presented in preterm labor and emergent cesarean section was performed. A true knot was present in the umbilical cord. APGARS were 1 at one minute and 7 at 5 minutes. He required cardiopulmonary resuscitation and intubation at the time of birth. He was treated with phenobarbital for presumed seizures which manifested as intermittent bradycardia. Right grade III and left grade IV IVH with resultant hydrocephalus was detected by head ultrasound on day of life 21. He was transferred to SLCH for further care. Neurosurgery placed a subgaleal shunt on day of life 25. There was concern for possible meningitis based on analysis of cerebrospinal fluid sampled from the shunt, but negative results were obtained from gram stain and culture. He was treated empirically for the possibility of meningitis. His hydrocephalus improved with the shunt, as demonstrated by head ultrasound. MRI showed dilatation of the ventricular system, with evidence of hemosiderin deposition within the ventricular lining, as well as focal blood products within the enlarged left lateral ventricle. Also noted were thinning of the corpus callosum and left periventricular white matter, as well as focal gliosis adjacent to the junction of the left thalamus and caudate, thought to represent a site of prior hemorrhage. The patient had many other medical complications of prematurity, including a patent ductus arteriosus (PDA) which was ligated, sepsis, hypothyroidism, adrenal insufficiency, retinopathy of prematurity, severe bronchopulmonary dysplasia. He demonstrated feeding intolerance and it was determined that he would be dependent on parenteral nutrition for life. A 'do not resuscitate' order was placed, and 'comfort care' was administered until the patient died on day of life 133 from respiratory failure.
