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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Status Marmoratus | 4A0 Case 4 History
Case 4 History ---- The patient was a 9 week old infant, born at 28 weeks EGA in a pregnancy complicated by maternal asthma, tobacco use, intrauterine growth restriction and Rh incompatibility. Premature labor commenced with placental abruption. The 1195 gram baby and, immediately after delivery, had respiratory distress, required intubation and entered the NICU at SLCH. He did well for the first two weeks and then acutely deteriorated with necrotizing enterocolitis. Post-operative course included Escherichia coli sepsis and pneumonia. Sonogram imaging at 17 days of life showed development of bilateral small subependymal hemorrhages without intraventricular extension. By 26 days he had periventricular leukomalacia with mild ventricular enlargement. Continuous sedation and sometimes paralysis was required for him to be adequately ventilated. By 60 days of life, he could not be oxygenated well in any ventilatory mode. He expired several days later. ---- At autopsy, the unfixed brain weighed 350g. It showed extensive bilateral periventricular leukomalacia with marked cavitation, hydrocephalus ex vacuo, small pyramidal tracts, and mineralization of thalamic neurons.
