Table of Contents
Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | White Matter | 1A0 Case 1 History
Case 1 History ---- The patient was a 9 week old male infant, born at 28 weeks gestational age in a pregnancy complicated by maternal asthma, tobacco use, intrauterine growth restriction and Rh incompatibility. Premature labor commenced with placental abruption. The baby weighed 1195 grams and, immediately after delivery, he was in respiratory distress, required intubation and entered the NICU at SLCH with a normal age-appropriate neurologic exam. He did well for the first two weeks and then acutely deteriorated with abdominal distension, acidosis with portal venous gas. He subsequently underwent laparotomy with a jejuno-ileostomy for necrotizing enterocolitis. His post-operative course was complicated by recurrent E. coli sepsis and pneumonia. During his hospital stay, he had several head sonograms. The first study revealed only small bilateral choroid plexus cysts, but subsequent imaging at 17 days of life showed development of bilateral small subependymal hemorrhages without intraventricular extension. By 26 days of life he was also noted to have evidence of periventricular leukomalacia with mild ventricular enlargement. Evaluation of his neurologic function was limited by the continuous sedation and sometimes paralysis that was required for him to be adequately ventilated. By 60 days of life, his respiratory status was so tenuous that he could not be oxygenated well in any ventilatory mode. He expired several days later.
