This week we had a case that was interesting. I work LDRP, but nursery was short and I was helping out in there and was unable to be in on the delivery or in the ICN w/the newborn, so my info is sketchy...but here goes.
If I remember correctly, mom's labs were not out of whack, she was being induced (vag cytotec? not sure of reason) and it was not long after that she had to be taken back for a c/s. This baby came out white, blood drawn looked like Koolaid....his crit was 10, his blood sugar in the 20's, metabolic acidosis of course, placed under hood, apnea spells, he received blood several times. I do not know how bp's were. Anyhow, baby was pinking up slightly when I peeked in on him...mostly from head to chest, but then pale again. The next morning he suffered seizures and was shipped out.
Interestingly enough, pediatrician said he hasn't seen this in his 25 years and ob/gyn didn't sound like he'd seen anything like it before. I don't know if patho found anything w/placenta, but this mom had a lot of fetal cells in her blood stream....I heard a comment that if she were negative she would have needed 10x's the amount of RhoGam required.
We called the hosp where he was shipped and EEG is not looking good last I heard.
Just curious, thanks,
Dec 3, '01
Was mom in a wreck or did she fall recently? Sounds like some sort of interruption of the maternal-fetal barrier.
Dec 3, '01
could also be some weird severe hemolytic problems. Sometimes you can see a sinusoidal fetal heart pattern. This is fairly rare. I would be curious to know why they did the c/s and her prematal history. Seems something may have been going on for a while. Usually with acute bloodloss or hypovolemia they tend to respond to blood fairly well.
thx for sharing
Dec 3, '01
Rdhdnurs-I had wondered about possible trauma to mother since I've been off work and going over this in my mind.
Kennedyj-I believe she was gravida 3, no complications of previous pregnancies and I think the c/s was due to nonreass. heart tones, but I will look at the actual strip to doublecheck when I get a chance.
kday-For some reason, from your posts you remind me of a good friend of mine...don't know, maybe you use the same words a lot?Anyway, there has gotta be more to this and I'm sure w/more time at the hospital baby went to, they will get to the bottom of it.
I work again tomorrow night and will be asking more "?"s if time allows. It's very interesting, but sometimes I wish I could turn the brain off to enjoy my only day off! Thanks guys for all of the responses. L
Dec 5, '01
We had a baby a while back with similar symptoms. the only difference was that he was okay for the first few hours. very low CBS, grey ashen color, out of whack labs. he was shipped and died a few days later. TRANSPOSITION OF THE GREAT VESSELS. the weird thing is, there was absolutly no audible murmur.
Dec 13, '01
I have been busy lately and not on the computer.
Unfortunately I have no news. The baby was off the vent, but condition hadn't improved otherwise. I will post more if / when I find out if anything changes. Also, OB/Gyn said there was no sinusoidal pattern.
Dec 16, '01
I cared for a baby years ago who presented a similar case (except the fetal cells in mom's blood). Cardiac w/u was negative. He was so unstable that we delayed doing a head U/S. Since he was a term infant born via C/S we really had no reason to suspect a head bleed anyway. When it was finally done, it revealed an A-V malformation the likes of which our neuro-surgeons had never seen before. They attempted surgery, but the poor little guy died a few days post-op. I'll never forget his beautiful little face or his loving mother.
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