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American Academy of Pediatrics
Index of Suspicion in the Nursery

Case 1: A 31-week Fetus with Intestinal Atresia and Sudden Fetal Hemorrhage

Adrienne Pahl, Robert Wildin, Marcia Wills and Whittney Barkhuff
NeoReviews November 2020, 21 (11) e761-e764; DOI: https://doi.org/10.1542/neo.21-11-e761
Adrienne Pahl
Departments of *Pediatrics and
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Robert Wildin
Departments of *Pediatrics and
†Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
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Marcia Wills
‡Department of Pathology, Shore Regional Health, University of Maryland Medical System, Baltimore, MD
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Whittney Barkhuff
Departments of *Pediatrics and
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A 34-year-old gravida 1, para 0 woman is pregnant with a fetus with known duodenal atresia and polyhydramnios. This pregnancy is the result of in vitro fertilization. Prenatal ultrasonography and fetal echocardiography findings are otherwise normal. Cell-free DNA testing is negative for trisomy and the parents decline amniocentesis. Family history is unremarkable at this time. Preterm premature rupture of membranes (PPROM) occurs at 31 weeks and 4 days of gestation, and the mother is admitted to the obstetrics department for continuous fetal monitoring. Latency antibiotics and betamethasone are administered.

Recurrent late decelerations are noted 46 hours after PPROM. Emergency cesarean delivery is performed under general anesthesia and the amniotic fluid is grossly bloody. The 2,115-g large-for-gestational age female infant emerges pale, apneic, and hypotonic. The initial heart rate is 40 beats/min. Large amounts of bloody secretions are suctioned from the mouth and airway. Bradycardia persists despite positive pressure ventilation with good chest movement. Chest compressions are performed, and the infant undergoes intubation. The infant continues to be bradycardic and hypoxic with weak pulses and poor perfusion. A low-lying umbilical venous catheter (UVC) is inserted, and normal saline and epinephrine are administered. The heart rate improves slowly as does the hypoxia. The infant’s Apgar scores are 0, 2, 3, and 4 at 1, 5, 10, and 15 minutes after birth. Arterial cord blood gas values are as follows: pH 7.10, partial pressure of carbon dioxide (Pco2) 65 mm Hg (8.6 kPa), bicarbonate 22 mEq/L (22 mmol/L), base deficit 19; venous cord blood gas values are as follows: pH 7.15, Pco2 58 mm Hg (7.7 kPa), bicarbonate 22 mEq/L (22 mmol/L), base deficit 9.7. The umbilical cord is noted to be grossly abnormal with short, curved vessels visible outside the Wharton jelly (Fig 1).

Figure 1.

Umbilical cord with …

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NeoReviews
Vol. 21, Issue 11
1 Nov 2020
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Case 1: A 31-week Fetus with Intestinal Atresia and Sudden Fetal Hemorrhage
Adrienne Pahl, Robert Wildin, Marcia Wills, Whittney Barkhuff
NeoReviews Nov 2020, 21 (11) e761-e764; DOI: 10.1542/neo.21-11-e761

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Case 1: A 31-week Fetus with Intestinal Atresia and Sudden Fetal Hemorrhage
Adrienne Pahl, Robert Wildin, Marcia Wills, Whittney Barkhuff
NeoReviews Nov 2020, 21 (11) e761-e764; DOI: 10.1542/neo.21-11-e761
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More in this TOC Section

  • Case 2: Abdominal Distention with Paralytic Ileus in a Neonate
  • Case 1: A Term Neonate with Conjunctival Hemorrhage, Ecchymoses, and Umbilical Hematoma
  • Case 3: Cystic Encephalomalacia and Hyperpigmented Plaques in a Preterm Infant
Show more Index of Suspicion in the Nursery

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