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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Status Marmoratus | 2A0 Case 2 History
Case 2 History ---- The patient was a 17 month old female born at full term delivered by ‘C’-section after a failed forceps and vacuum suction attempt and a maternal temperature of 38.8°C. Upon delivery the patient had fetal tachycardia, was then intubated with difficulty and CPR was begun. Meconium was aspirated. The patient also had bradycardia and cyanosis and was reintubated. At 14 months of age, the baby only making ”ga-ga“-type sounds, had difficulty with visual tracking, a hearing defect and was quadriparetic. MRI showed multifocal signal intensities in the brainstem and anterior thalamus. Recent history was negative except for having a febrile illness one month before presentation. Three days before the current admission she had an upper respiratory tract infection, otitis media, a sore throat and fever. She was started on Augmentin. The next morning the parents found the patient in bed cold, clammy, unresponsive and seizing. She was transported to an OSH with a temperature of 106°F and had evidence of poor perfusion. Ativan stopped the seizures. She had two episodes of bradycardia with a heart rate down to the 30s and responded twice to Epinephrine. She was put on fluids and Dopamine and was transferred to SLCH. Upon arrival her heart rate was 220 with wide complex tachycardia with no perfusion detectable; chest compressions were begun and she was sent to the Pediatric ICU. Labs showed: CSF glucose 36, CSF protein 36, CSF cell count 8 with two nucleated cells. Her blood gas was pH 7.24, CO2 was written as 57, O2 written as 24, calculated Bicarb 25. Her heart rhythm slowed and she developed asystole. Despite an aggressive resuscitative effort, she was declared dead. ---- At autopsy unfixed brain weight was 820g with remote hypoxic/ischemic injury including white matter astrocytosis and calcifications, status marmoratus involving the basal ganglia and thalamus, hippocampal sclerosis, and cerebellar central lobular sclerosis.
