A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta
Introduction. Coarctation of the aorta (CoA) occurs in 6-8% of patients with congenital heart disease, with an incidence of 4/10,000 live births. It can be present with various clinical pictures, in an age range between newborn and adolescence. Infants with birth weights ≤ 2 kg with CoA have increa...
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| Format: | Article |
| Language: | English |
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Amaltea Medical Publishing House
2022-06-01
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| Series: | Romanian Journal of Pediatrics |
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| Online Access: | https://rjp.com.ro/articles/2020.2/RJP_2020_2_EN_Art-22.pdf |
| _version_ | 1797804425598730240 |
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| author | Andreea Cerghit Paler Dorottya Miklosi Liliana Gozar Rodica Toganel Amalia Fagarasan Daniela Toma |
| author_facet | Andreea Cerghit Paler Dorottya Miklosi Liliana Gozar Rodica Toganel Amalia Fagarasan Daniela Toma |
| author_sort | Andreea Cerghit Paler |
| collection | DOAJ |
| description | Introduction. Coarctation of the aorta (CoA) occurs in 6-8% of patients with congenital heart disease, with an incidence of 4/10,000 live births. It can be present with various clinical pictures, in an age range between newborn and
adolescence. Infants with birth weights ≤ 2 kg with CoA have increased risk of severe intraventricular hemorrhage (IVH) compared to their birth weight-matched cohorts. Case presentation. We present a case of a premature, male newborn, with low birth weight, who at the age of 3 weeks developed signs and symptoms of cardiogenic shock. Clinical examination, echocardiography and angio-CT confirmed the diagnosis of a severe CoA, without any flow through the ductus arteriosus. Treatment with prostaglandin E1 was initiated, to promote ductal patency. The systolic blood pressures were above 99 percentile for his gestational age in the upper extremities, with a noninvasive pressure gradient around 86 mmHg between the arm and leg. Transfontanellar ultrasonography evaluation revealed a grade II/III bilateral IVH, in resorption, with cystic transformation. At the age of 6 weeks definitive surgical repair was performed. Postoperatively, at the 3 month follow-up, the clinical suspicion of recoarctation of the aorta arose, confirmed by echocardiography and angio-CT, with arterial
hypertension and gradient around 37 mmHg between the arm and leg. Prosthetic patch aortoplasty was performed. The postoperative evolution was marked by the persistence of arterial hypertension, the infant requiring continued treatment with angiotensin-converting enzyme inhibitor. Conclusions. Premature neonates with low birth weight have always constituted a medical management challenge, with short and long term implications. A strong point in solving such cases is a multidisciplinary medical for assessment, management and outcomes. |
| first_indexed | 2024-03-13T05:36:58Z |
| format | Article |
| id | doaj.art-dcfe220d22b94f54bb3afcdfb85972c3 |
| institution | Directory Open Access Journal |
| issn | 1454-0398 2069-6175 |
| language | English |
| last_indexed | 2024-03-13T05:36:58Z |
| publishDate | 2022-06-01 |
| publisher | Amaltea Medical Publishing House |
| record_format | Article |
| series | Romanian Journal of Pediatrics |
| spelling | doaj.art-dcfe220d22b94f54bb3afcdfb85972c32023-06-14T07:28:18ZengAmaltea Medical Publishing HouseRomanian Journal of Pediatrics1454-03982069-61752022-06-0169219219710.37897/RJP.2020.2.22A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aortaAndreea Cerghit Paler0Dorottya Miklosi1Liliana Gozar2Rodica Toganel3Amalia Fagarasan4Daniela Toma5Paediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Tg. Mures, RomaniaPaediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Tg. Mures, RomaniaPaediatric Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Tg. Mures, RomaniaPaediatric Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Tg. Mures, RomaniaPaediatric Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Tg. Mures, RomaniaPaediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, Tg. Mures, RomaniaIntroduction. Coarctation of the aorta (CoA) occurs in 6-8% of patients with congenital heart disease, with an incidence of 4/10,000 live births. It can be present with various clinical pictures, in an age range between newborn and adolescence. Infants with birth weights ≤ 2 kg with CoA have increased risk of severe intraventricular hemorrhage (IVH) compared to their birth weight-matched cohorts. Case presentation. We present a case of a premature, male newborn, with low birth weight, who at the age of 3 weeks developed signs and symptoms of cardiogenic shock. Clinical examination, echocardiography and angio-CT confirmed the diagnosis of a severe CoA, without any flow through the ductus arteriosus. Treatment with prostaglandin E1 was initiated, to promote ductal patency. The systolic blood pressures were above 99 percentile for his gestational age in the upper extremities, with a noninvasive pressure gradient around 86 mmHg between the arm and leg. Transfontanellar ultrasonography evaluation revealed a grade II/III bilateral IVH, in resorption, with cystic transformation. At the age of 6 weeks definitive surgical repair was performed. Postoperatively, at the 3 month follow-up, the clinical suspicion of recoarctation of the aorta arose, confirmed by echocardiography and angio-CT, with arterial hypertension and gradient around 37 mmHg between the arm and leg. Prosthetic patch aortoplasty was performed. The postoperative evolution was marked by the persistence of arterial hypertension, the infant requiring continued treatment with angiotensin-converting enzyme inhibitor. Conclusions. Premature neonates with low birth weight have always constituted a medical management challenge, with short and long term implications. A strong point in solving such cases is a multidisciplinary medical for assessment, management and outcomes.https://rjp.com.ro/articles/2020.2/RJP_2020_2_EN_Art-22.pdfcoarctation of the aortaintraventricular hemorrhageprematuritylow birth weight |
| spellingShingle | Andreea Cerghit Paler Dorottya Miklosi Liliana Gozar Rodica Toganel Amalia Fagarasan Daniela Toma A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta Romanian Journal of Pediatrics coarctation of the aorta intraventricular hemorrhage prematurity low birth weight |
| title | A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta |
| title_full | A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta |
| title_fullStr | A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta |
| title_full_unstemmed | A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta |
| title_short | A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta |
| title_sort | rare case of cerebral hemorrhage in a pre term infant with coarctation of the aorta |
| topic | coarctation of the aorta intraventricular hemorrhage prematurity low birth weight |
| url | https://rjp.com.ro/articles/2020.2/RJP_2020_2_EN_Art-22.pdf |
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