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American Academy of Pediatrics
Visual Diagnosis

A Newborn Who Has Acidemia and Abnormal Head Ultrasonography

Henry Lee and Omar Abdul-Rahman
NeoReviews September 2005, 6 (9) e439-e442; DOI: https://doi.org/10.1542/neo.6-9-e439
Henry Lee
Department of Pediatrics, Division of Neonatology, Stanford University Medical Center, Stanford, Calif.
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Omar Abdul-Rahman
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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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NeoReviews
Vol. 6, Issue 9
1 Sep 2005
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A Newborn Who Has Acidemia and Abnormal Head Ultrasonography
Henry Lee, Omar Abdul-Rahman
NeoReviews Sep 2005, 6 (9) e439-e442; DOI: 10.1542/neo.6-9-e439

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A Newborn Who Has Acidemia and Abnormal Head Ultrasonography
Henry Lee, Omar Abdul-Rahman
NeoReviews Sep 2005, 6 (9) e439-e442; DOI: 10.1542/neo.6-9-e439
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  • Severe Intrauterine Growth Restriction, Thrombocytopenia, and Direct Hyperbilirubinemia in a 26-week Premature Infant
  • An Unexpected Brain Lesion in a 2-month-old Infant
  • A Large Tortuous Umbilical Cord with Superficial Abdominal Wall Varicose Veins in a Newborn
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