Table of Contents
Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Pontosubicular necrosis | 2A0 Case 2 History
Case 2 History ---- The patient was a female infant born at 29-4/7-week EGA to a 21-year-old G4P3 now 4 mother. The mother’s prenatal serologies showed she was hepatitis C positive and HIV negative. In addition, her pregnancy was complicated by polyhydramnios, antenatal diagnosis of gastroschisis, preterm labor, cigarette smoking and past illicit drug use. She presented to an OSH on Dec 3 in progressive labor. Emergent C-section was performed. She initially had copious secretions and was intubated by 1 minute of life. Apgar scores were 1 (1 min), 4 (5 min) and 6 (10 min). The infant was stabilized in the delivery room and transferred to the NICU. A large gastroschisis involved the liver, intestines and stomach. A Replogle was placed for continuous suction. The infant was positioned right side down to prevent possible occlusion of blood supply to the bowel which was covered with warm saline soaks and Saran wrap. Initial ABG was concerning for a pH of 6.94, PCO2 123, PO2 of 50 and a bicarbonate level of 26. Surfactant was administered and she was subsequently transferred to the SLCH. On arrival at SLCH her gastroschisis was placed in a Silastic silo, and the bowel was decompressed with Replogle to LCS. Pediatric Surgery attempted to gradually reduce the gastroschisis defect; however, the defect was too large. She had problems with both ventilation and oxygenation and she developed severe generalized anasarca with severe oliguria. Serial head sonograms also showed a progression of intracranial hemorrhage in the right caudate nucleus, extending to the thalamus. Her parents expressed their wish to redirect care and the baby passed away. ---- At autopsy brain weight was 199g (nl for age = 180 + 34g). There was diffuse hypoxic/ischemic encephalopathy, involving gray and white matter, a subacute basal ganglia infarct and Purkinje cell loss.
