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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Porencephaly | 11A0 Case 11 History
Case 11 History ---- The patient was a 13 month old male who had suffered many of the complications associated with prematurity. He was hospitalized for ten of the thirteen months of his life. He was the 1800 gram EGA 34 week product of a 20 year old para 2 gravida 1 mother whose pregnancy was complicated by the use of birth control pills during the first half of her pregnancy. There was a premature rupture of membranes and delivery at Barnes Hospital was by Caesarean section. Apgars were 9 and 10. Hyaline membrane disease and bronchopulmonary dysplasia necessitated mechanical ventilation with 100% oxygen at SLCH. A patent ductus arteriosus and secondary congestive heart failure resolved spontaneously. Subarachnoid hemorrhage (presumptively intraventricular hemorrhage) was diagnosed on his 2nd day of life by lumbar puncture and was treated with serial lumbar punctures and glycerol. Serial CT scans, the first being at the age of 3 weeks, showed progressive ventricular dilatation and decreased white matter densities periventricular and more prominently in the frontal lobes. He was discharged on March 26th on oral glycerol with a head circumference of 40 cms. He was readmitted on April the 6th with bronchial pulmonary dysplasia, superimposed· pneumonia and seizures. Because of an increasing head circumference of 43 cms and increasing ventricular size on CT scans (which also showed a right frontal porencephalic cyst), a ventriculoperitoneal shunt was placed on April 26th. Discharge was on May 5th and medications included phenobarbital for seizure control and digoxin and aldactazide for signs of congestive heart failure. The 3rd SLCH was 6/22 for respiratory difficulty felt to be secondary to cor pulmonale related to his bronchopulmonary dysplasia. Fluid balance, chronic hypoxemia requiring temporary mechanical ventilation, and poor feeding were persistent problems. Subsequent hospital management problems again centered around hypoxemia, congestive heart failure and poor nutrition. Signs of worsening congestive heart failure appeared despite vigorous medical therapy. Azotemia developed with BUN's greater than 50. Two generalized tonic seizures occurred on 2/1 and a postictal right hemiparesis was noted. Death occurred on 2/2 at the age of 13 months, over 4 months into his final hospitalization.
