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Washington University Experience | VASCULAR | Hypoxia-Ischemia, neonate, Multicystic Encephalopathy (MCE) | 2A0 Case 2 History
Case 2 History ---- The decedent was a 20-year-old woman with a history of perinatal hypoxic ischemic encephalopathy resulting in spastic quadriplegia and cerebral palsy, intractable epilepsy, non-obstructing kidney stones, recurrent Klebsiella UTIs secondary to neurogenic bladder and chronic Foley placement, AKI, chronic respiratory failure requiring tracheostomy, and GJ tube dependence. She presented in June 2019 after several weeks of increasing oral, nasal, and tracheostomy secretions and two days of decreased activity with intermittent cough and sneezing which did not improve. A chest x-ray showed bibasilar atelectasis. Antibiotics were started and she was admitted to Barnes-Jewish Hospital and had a prolonged hospital stay with multiple courses in the pediatric intensive care unit for septic shock resulting from urosepsis with and without bacteremia. She required maximal medical management which included advanced invasive ventilation, pressors, exploratory laparotomy for abdominal compartment syndrome, kidney failure and bilateral tarsoraphy for refractory corneal abrasions. Her last PICU course began In November 2019 with another episode of urosepsis with progression to severe hypotension, profound acidosis, and episodes of cardiac arrest. Her parents decided not to pursue additional CPR after prolonged discussion with the clinical team. Shortly thereafter she progressed to severe multi-organ failure and her family agreed to de-escalate care and pursue comfort measures. ---- At autopsy the brain weighed 310 grams.
