Severe Intrauterine Growth Restriction, Thrombocytopenia, and Direct Hyperbilirubinemia in a 26-week Premature Infant

Bengt-Ola S. Bengtsson; John P. van Houten

doi:10.1542/neo.22-1-e68

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The Case

A 5-day-old symmetric severely growth-restricted preterm newborn with thrombocytopenia, anemia, and direct hyperbilirubinemia has abnormal cranial ultrasonography findings (Figs 1A and 1B, 2A and 2B).

Figure 1.

Cranial ultrasound. A, Coronal view. B, Sagittal view. Showing hyperechoic area (arrows) suggestive of cortical calcification.

Figure 2.

Cranial ultrasound. A, Sagittal view. B, Coronal view. Showing area of encephalomalacia (arrows) within the upper right temporal/lower parietal lobe and with effacement of the right lateral ventricle due to mass effect.

Prenatal and Birth Histories

Born to a 31-year old gravida 3, para 3, Hispanic woman.
Prenatal maternal laboratory findings: Rapid plasma reagin negative, human immunodeficiency virus negative, rubella immune, hepatitis B surface antigen negative, group B Streptococcus status unknown. No history of genital herpes simplex virus infection.
Maternal vaginal bleeding between 6 and 13 weeks’ gestation; a subchorionic hemorrhage was identified at 13 6/7 weeks’ gestation, which resolved on subsequent ultrasonography at 17 6/7 weeks’ gestation.
Fetal survey at 17 weeks’ gestation showed no abnormalities.
Noninvasive prenatal testing for fetal cell free DNA was normal.
Pregnancy also complicated by severe intrauterine growth restriction (IUGR) first noted at 21 6/7 weeks’ gestation with an estimated fetal weight of 300 g. Additional invasive obstetrical testing to identify the etiology of the IUGR was not done. There was no history of maternal hypertension or evidence of preeclampsia.
Decreased amniotic fluid volume was first noted at 21 6/7 weeks’ gestation, which persisted on repeat examinations. There was no premature rupture of membranes.
Anhydramnios and a nonreassuring fetal heart rate pattern noted during a scheduled obstetrical outpatient visit at 26 0/7 weeks’ gestation. Ultrasonography estimated fetal weight at that time to be 407 g (consistent with 21 4/7 weeks’ gestation). One dose of antenatal steroids was administered 3 hours before delivery.
Admitted to the hospital for aforementioned findings and emergent cesarean section done at …