Case 3: Cystic Encephalomalacia and Hyperpigmented Plaques in a Preterm Infant

Presentation

A previously healthy 27-year-old gravida 1, para 0 woman is admitted with preterm labor and loss of fluids at 28 weeks’ gestation. She receives antenatal steroids and obstetric ultrasonography shows bilateral cerebral ventriculomegaly and an absent stomach bubble. Before admission, her pregnancy had been uneventful and findings on early anomaly screening ultrasonography at 19 weeks’ gestation are normal. Serologic tests for maternal group B Streptococcus, cytomegalovirus, toxoplasma, and Treponema all have negative findings.

The fetal tracing becomes non-reassuring and the neonate is born via emergency cesarean delivery. The neonate has apnea, hypotonia, and bradycardia at birth and does not respond to face mask ventilation. He undergoes intubation by 5 minutes after birth, with improvement in his heart rate, but he remains limp without any spontaneous breathing. His Apgar scores are 1, 2, and 3 at 1, 5, and 10 minutes after birth, respectively. Arterial and venous cord blood gases are 7.29 pH and 7.36 pH.

Initial examination shows a preterm infant with appropriate weight, length, and head circumference for age, decorticate posturing, hypotonia of the lower extremities, …