Table of Contents
Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Cerebellum | 4A0 Case 4 History
Case 4 History ---- This 23 6/7 EGA infant was born to a 41 year old G3P2 mother. Pregnancy was complicated by hypertension (chronic), preeclampsia (treated with Mg sulfate), and maternal pulmonary edema. She delivered via C-section secondary to breech presentation and severe preeclampsia with Apgar scores of 1, 5 and 7 (1,5,10 minutes), with a birth weight of 500 grams. She was hypotonic and cyanotic and underwent chest compressions, receiving epinephrine via ET tube in the delivery room. She received surfactant at 0 and 72 hours, as well as prophylactic indomethacin. On day of life 4, she self extubated and was then reintubated. Shortly after extubation, she underwent sepsis evaluation for worsening respiratory status with a distended and discolored abdomen. At that time, she had a Hgb of 7.8 and a platelet count of 51K. Abdominal radiograph showed pneumatosis and she was transported to SLCH for further management. During transport, she became hypotensive (MAPs in low 20's) and was given dopamine with subsequent improvement. She presented to SLCH in respiratory acidosis and a peritoneal drain was placed for spontaneous bowel perforation. She was initially placed on ampicillin, gentamicin and clindamycin. Abdominal fluid culture obtained at the time of Penrose drain placement grew moderate coagulase - staphylococcus. On DOL#11, she had increased abdominal discoloration and completed a subsequent course of vancomycin, meropenem and prophylactic fluconazole. Head ultrasound on DOL#10 showed a right cerebellar hemorrhage. Repeat head U/S on DOL#12 showed beginning transformation of the right cerebellar intraparenchymal hemorrhage. Repeat HUS at 1 month of age showed evolving cystic transformation of right cerebellar hemorrhage and periventricular white matter echogenicities. Echocardiogram obtained on DOL#11 showed mild pulmonary stenosis, mild LVH, a PFO with left to right shunting, but no PDA. She had multiple X-rays with findings consistent with bronchopulmonary dysplasia. On DOL #61 she developed a distended, firm abdomen with bright red blood per rectum and blood per G-tube. She underwent an exploratory laparotomy and was found to have pan-intestinal necrotizing enterocolitis, at which time care was redirected and she died the following day. ---- Autopsy findings included organizing cerebellar hemorrhage, granular ependymitis and focal subarachnoid hemorrhage at the base of cerebellum.
