Case 3: Abdominal Rash After Removal of Umbilical Vessel Catheter Anchor in a Preterm Infant
| Autor: | Charles D. Mitchell, Jocelyn Ou, Waleed Kurtom |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Polyhydramnios
medicine.medical_specialty Pregnancy Respiratory distress business.industry Obstetrics Umbilicus (mollusc) Intrauterine growth restriction medicine.disease 03 medical and health sciences Catheter 0302 clinical medicine medicine.anatomical_structure 030225 pediatrics Ductus arteriosus Pediatrics Perinatology and Child Health Rupture of membranes Medicine 030212 general & internal medicine business |
| Zdroj: | NeoReviews. 19:e250-e253 |
| ISSN: | 1526-9906 |
| DOI: | 10.1542/neo.19-4-e250 |
| Popis: | A 635-g female infant is born at 25 weeks of gestation to a 36-year-old gravida 1, para 0 woman. The infant is twin B of a monochorionic-diamniotic twin gestation. The pregnancy is complicated by intrauterine growth restriction in twin A and polyhydramnios in twin B. The woman is a carrier for Gaucher disease and α1-antitrypsin deficiency and the family history is noncontributory. Prenatal screening for syphilis, human immunodeficiency virus, hepatitis B, hepatitis C, and Toxoplasma are negative and rubella immune. Group B Streptococcus status is unknown. Maternal history is negative for herpes simplex virus (HSV) and she denies having any lesions before or during pregnancy. The infants are born via emergency delivery because of the reversal of flow on umbilical arterial Doppler ultrasonography performed for twin A; rupture of membranes occurs at delivery. The infant’s Apgar scores are 6 at 1 minute and 7 at 5 minutes. Vital signs are within normal limits, and physical examination findings at birth are unremarkable. On admission to the NICU, she develops severe respiratory distress necessitating intubation, surfactant administration, and synchronized intermittent mandatory ventilation. An umbilical venous catheter is placed and reinforced with an umbilical vessel catheter anchor. A blood specimen is obtained for culture and empirical antibiotic given for respiratory distress. On postnatal day 2, she is switched to high-frequency oscillatory ventilation because she is hypercapnic. Echocardiography reveals a large patent ductus arteriosus with bidirectional shunting, which subsequently closes on postnatal day 5 after 5 doses of ibuprofen. On postnatal day 7, the umbilical venous catheter and anchor are removed and the skin to the right of the umbilicus abraded. On postnatal day 14, the medical team notices new pustular and vesicular lesions (Fig) on her abdomen over the same area. Further laboratory investigations confirm the diagnosis. Figure. Pustular (white arrows) and … |
| Databáze: | OpenAIRE |
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