July Case Study - Prophylactic barbiturate use for presentation of morbidity and mortality following perinatal asphyxia

Patient Profile

• Name: Baby X

• Age: Newborn

• Gestational Age: 39 weeks

• Birth Weight: 3.2 kg

• Delivery: Vaginal, with the assistance of forceps

• APGAR Scores: 3 at 1 minute, 5 at 5 minutes, and 7 at 10 minutes

Clinical Presentation

Baby X was born after a prolonged second stage of labor. The mother, a 28-year-old G2P1, had an uncomplicated pregnancy until delivery. The baby was delivered with the assistance of forceps after a total labor duration of 14 hours. Upon birth, Baby X had a weak cry, poor muscle tone, and cyanosis.

Initial Management

• Immediate Actions:

• Cut the umbilical cord

• Place the baby on the radiant warmer and thoroughly dry and stimulate the baby from head to toe (must take less than 30 seconds)

• Airway was cleared due to visible mucus and positive pressure ventilation was initiated.

• Oxygen was administered.

• Subsequent Actions:

• The baby was transferred to the neonatal intensive care unit (NICU).

• Blood gases showed metabolic acidosis.

• The baby was placed on a mechanical ventilator.

• Therapeutic hypothermia was initiated to reduce the risk of hypoxic-ischemic encephalopathy (HIE).

Diagnostic Findings

• Blood Gas Analysis:

• pH: 7.1

• PaO2: 50 mmHg

• PaCO2: 55 mmHg

• HCO3: 15 mmol/L

• Base Excess: -12 mmol/L

• Imaging:

• Brain ultrasound: Signs of cerebral edema.

• Laboratory Tests:
  

• Elevated serum lactate levels.

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Multiple Choice Questions

What is the most likely cause of Baby X’s condition?

• A - Congenital heart defect
• B - Birth asphyxia
• C - Neonatal sepsis
• D - Inborn error of metabolism

Which of the following is a primary goal in managing this baby?

• A - Administering antibiotics
• B - Providing immediate respiratory support
• C - Performing immediate surgery
• D - Ensuring adequate feeding

What is the purpose of therapeutic hypothermia in the management of birth asphyxia?

• A - To prevent hypoglycemia
• B - To reduce the metabolic rate and prevent brain injury
• C - To treat neonatal jaundice
• D - To improve cardiac function

Which of the following is NOT a typical feature of birth asphyxia?

• A - Poor muscle tone
• B - Weak cry at birth
• C - Cyanosis
• D - Hyperglycemia