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The Case:
A newborn male infant presents with profound acidemia and abnormal head ultrasonography findings.
Prenatal History:
13-year-old primigravida Caucasian mother with no prenatal care
Pregnancy is suspected to be caused by the older brother of the mother
Birth History and Presentation:
The delivery, which occurred at home without medical supervision, was vaginally into a toilet in which the baby remained until paramedics arrived at approximately 20 minutes after birth. Upon their arrival, an Apgar score of 9 was assigned. The infant was warmed, dried, and transported to the community hospital. Birthweight was 2,300 g. The infant was admitted initially to the well newborn nursery. However, 6 hours after arrival, the infant exhibited increased respiratory distress.
A blood gas drawn from an umbilical venous line revealed:
pH of 7.08
PCO2 of 10 mm Hg
PO2 of 73 mm Hg
HCO3 of 3 mEq/L
Base deficit of 24 mEq/L
The infant was transported to a neonatal intensive care unit (NICU).
Case Progression:
On arrival to the NICU, the patient was intubated and placed on mechanical ventilation. An echocardiogram revealed normal cardiac structure and function. The blood lactate level was elevated at 225.2 mg/dL (25 mmol/L). Blood ammonia concentration also was elevated at 518 mmol/L. Ketones were noted in the urine.
Vital Signs were:
Heart rate of 144 beats/min
Respiratory rate of 58 breaths/min
Blood pressure of 56/43 mm Hg
Oxygen saturation of 99% in room air
Temperature of 98.1?F (36.7?C)
Physical Examination
Weight, 2,300 g; length, 48 cm; head circumference, 35.5 cm
HEENT: Prominent occiput and sloping forehead; anterior and posterior fontanelles open, widely spaced, and boggy; palate intact
Lungs: Clear equal breath sounds bilaterally
Cardiac Examination: …
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