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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | White Matter | 4A0 Case 4 History
Case 4 History ---- The patient was a full-term female infant born on 12/14 to a 26 year old G2P1 mother, whose pregnancy was uncomplicated other than the mother required antibiotics during delivery for Group B streptococcus. The delivery (at 41 weeks) was difficult, requiring vacuum extraction. The baby was born without heartbeat and consequently suffered hypoxic damage to multiple organ systems. The infant weighed 5,087g. At birth, she was revived with CPR and intubated. Her Apgar scores were 0 at 1 minute and 2 at 5 minutes, 4 at 10 minutes and 6 at 15 minutes. She was bleeding from the mouth and nose and had a large subgaleal hemorrhage resulting in hypotension and DIC. She had a seizure and was loaded with Phenobarbital. Seven hours after birth she was transferred to SLCH for further management and care. On echocardiogram she had patent ductus arteriosus with left to right flow. Her platelet count was 91,000 and PT was 19.5. She was treated with fresh frozen plasma and packed red blood cells. Blood cultures for bacteria and fungi were negative. She had conjugated hyperbilirubinemia. MRI showed probable cortical laminar necrosis with a large bilateral cephalohematoma and subgaleal bleed. Bronchoscopy showed bronchomalacia. She was on peritoneal dialysis for renal failure and required ventilatory support. She was able to be weaned off of pressors. On 1/15 she became bradycardic. Resuscitation efforts were unsuccessful. ---- The patient was 4 weeks of age at the time of death. Brain weight was 330 g (normal for age=461-595 g)
