Question: What is it that this infant boy born on 5/9/00 has? Is it an IEM? Hypoxic Injury?
An infant boy was born 5/9/00 to a 34 year old, A pos, gravida 2, para 1, white female after a 38 week gestation. Complications of pregnancy included PIH last 5 days of pregnancy. The EDC was 5/4/00. Membranes were ruptured 2 hrs. PTD. The amniotic fluid was clear. Delivery was spont. vag. delivery under epidural/local anesthesia. 1 min. apgar was 6, the 5 min. apgar was 7. Resuscitation included: blowby oxygen.
Neuro: The child developed seizures almost immediately after birth, requiring TX with Phenbarb, Dilantin and Activan. LP done which was bloody. Initial CT showed subarachnoid blood. EEG showed burst suppression pattern. EEGs on 5/10, 5/11, 5/15, 5/26 and 6/5 all showing persistence of burst suppression. MRI on 5/18 showed scattered areas of subarachnoid blood, increased signal intensity and some hemorrhage within the Basal Ganglia. The child received Ativan 5/10, 5/25 - PRN) Phenobarb since 5/1 0; Pyridoxine - 100 mg on 5/11, 5/25, 5/26; Felbatol started 5/26 to 6/1. Still on Phenobarb 6/8/00.
Resp: The child was intubated for sedative effects of seizure meds as well as neuro status from 5/10 to 6/1. Off ventilator on 6/1 with some episodes ofshallow breathing. Seizures can cause infant to stop breathing but recovers if stimulated.
CV: The child received pressors from 5/10 - 5/12. He also received Albumin X2 during that time for Hypotension.
ID: The child was placed on empiric amp/gent after birth; more recently he received a course of anco for positive blood culture for staph EPI on 5/24.
Physical exam: wt: 3540 grams, hc: 36.2 cms, length: 50cms, hr: 132, rr: 33, temp: 99.1, bp: 61/33, mean:42
Gen. App: Pink, SGA Heent: AF- open flat, eyes: red, reflex bilaterally, ear canals: patent, palate: intact, neck: supple without masses, lungs: BS clear bilaterally, heart: RR without murmur, sounds normal, abdomen: soft without masses or organoegaly, genitalia: normal, rectal: anus patent, extremities: FROM, pulses 2+, hips and clavicles intact. Infant can hear and see.
Neonatal Metabolic Screening Lab results from sample date 5/11/00, a partial listing of some of the high levels (umole / L): Glutamic Acid = 8, Asparagine = 11, Glycine = 12, Glutamine = 624, Threonine = 48, Alanine = 25, Tyrosine = 28, Valine = 23, Methionine = 6. On 6/1 an Amino Acid Qunt. Serum was borderline elevation in Serum Glycine to 528uM. The CSF serum ratio is also borderline elevated at 0.032.
Is there anything else we could look for? Maybe narrow down our search to a specific area? Thank you for time.