Luke is a 26-week gestation infant born by precipitous vaginal delivery, weighing 890g. The…

Luke is a 26-week gestation infant born by precipitous vaginal delivery, weighing 890g. The pregnancy had been complicated with intermittent vaginal bleeding from 12 weeks’ gestation. Following the premature rupture of membranes, his mother was transferred to a tertiary perinatal centre four days prior to his delivery. His mother received erythromycin and betamethasone. Several hours prior to delivery his mother began to feel unwell with an increased temperature and uterine tenderness. Luke delivered following a further APH. He required resuscitation at birth including intubation and positive

View complete question »Luke is a 26-week gestation infant born by precipitous vaginal delivery, weighing 890g. The pregnancy had been complicated with intermittent vaginal bleeding from 12 weeks’ gestation. Following the premature rupture of membranes, his mother was transferred to a tertiary perinatal centre four days prior to his delivery. His mother received erythromycin and betamethasone. Several hours prior to delivery his mother began to feel unwell with an increased temperature and uterine tenderness. Luke delivered following a further APH. He required resuscitation at birth including intubation and positive pressure ventilation. Following a dose of surfactant, he was transferred to the neonatal intensive care unit. What antenatal factors place Luke at risk for GMH/IVH and/or PVL brain injury? On admission to NICU, Luke was commenced on synchronised intermittent positive pressure ventilation. Umbilical venous and arterial catheters were inserted. Findings consistent with respiratory distress syndrome were evident on his chest X-ray. He went on to receive a further two treatment doses of surfactant. In the first 24 hours of life Luke’s blood pressure was problematic and he required two doses of volume expansion which was followed by inotropic support. On day three Luke became more unstable and hypotensive. There was a murmur present on auscultation and a patent ducts arteriosis was confirmed on cardiac echo. On the routine day 7 head ultrasound scan there was evidence of intraventricular haemorrhage with blood present in normal-sized ventricles. During Luke’s initial care and management what potential mechanisms for injury were present and how could the presentation of his IVH be described? Identify potential care-giving practices that may aid in the prevention and management of IVH. Follow-up head ultrasound scan at 14 days of age revealed further bleeding had occurred and the ventricles were now slightly dilated. Despite this, Luke’s condition had allowed him to be intubated to continuous positive airways pressure (CPAP). Further regular ultrasounds were planned as although it was unlikely that further bleeding would occur, there was risk of post-haemorrhagic hydrocephalus. Successive scans showed mild progressive dilation which stopped at around 30 days. During this period Luke appeared well and his head circumference remained unchanged. What is Luke’s likely long-term outcome?

View less »