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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Category: Case reports (Page 1 of 20)

Clonidine for neonatal abstinence syndrome: a single neonatology department’s experience

Abstract

Clonidine has been shown effective in reducing sympathetic hyperactivity in neonatal abstinence syndrome (NAS). The aim of this study was to analyze clinical and laboratory characteristics of a group of newborns treated with clonidine for NAS due to maternal drug addiction and due to withdrawal from opioid analgesic therapy. Only one full–term newborn presented with metabolic acidosis and hyperkalemia; in others no clinical or laboratory adverse effects were detected. This report emphasizes the importance of alertness to potential adverse effects of clonidine therapy, and discusses possible pathophysiological aspects of hyperkalemia and metabolic acidosis during treatment for NAS.

Key words: newborn, sympathetic hyperactivity, metabolic acidosis, hyperkalemia

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Invasive malplacentation of lower uterine segment in first trimester patient with obstetric shock development

Abstract

We present a case of invasive malplacentation of the lower uterine segment found in a first trimester, 38-year old woman following curettage for missed abortion. Uncontrolled hemorrhage and obstetric hemorrhagic shock developed, resulting in abdominal hysterectomy, with resuscitation. The patient made a full recovery.

Key words: invasive placentation, first trimester, hysterectomy, obstetric shock

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Life saving use of ECMO in an obstetric patient with massive hemorrhage following uterine atony: a case report

Abstract

The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric patient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abortion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Postoperatively, she was referred to the intensive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinuation of ECMO, her treatment was further complicated by a manifest hemolytic transfusion reaction. Although extensive testing was done to establish the cause of this reaction, we were unable to find it. The patient responded well to treatment with erythropoietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the importance of early aggressive treatment using ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood products.

Key words: ECMO (extracorporeal membrane oxygenation), hemorrhagic diathesis, obstetric patients

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Uncommon manifestations of neonatal group b Streptococcus infection: case report and literature review

Abstract

Streptococcus agalactiae, also called Group B Streptococcus (GBS), is a common pathogen in the neonatal period that can cause early- and late-onset infections. The most common manifestations are bacteremia without an apparent focus of infection, pneumonia and meningitis. Additionally, GBS can rarely cause early- and late-onset infections with uncommon manifestations. If they go unrecognized, they may lead to inappropriate treatment and increased neonatal morbidity and mortality. In this article, a case report of an infant with early-onset GBS bullous impetigo is presented together with a short review of other uncommon manifestations of GBS infection.

Key words: Streptococcus agalactiae, infection, newborn

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Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support

Abstract

Extracorporeal membranous oxygenation (ECMO) is a life-saving treatment for paediatric patients with cardiac or respiratory failure of diverse aetiology. ECMO support is implemented only when all other available medications and procedures fail to treat the underlying cause of organ failure. The reason for caution is a high risk of complications, including intravascular haemolysis, bleeding or clot formation, inflammation and sepsis. Platelet count is closely monitored in assessment of bleeding risk associated with ECMO support. Platelets are counted as a parameter of the complete blood count and can be measured using impedance or optical technology. We report a case of severe red blood cell (RBC) fragmentation in a neonate on ECMO in whom erroneously normal platelet counts were obtained by all available automated methods for platelet count in an emergency laboratory. Based on those observations we have implemented an additional procedure for recognising interferences of fragmented and microcytic RBCs that cause spuriously normal platelet counts.

Key words: platelet count, ECMO, fragmented RBC, neonates, analytical interference

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