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  • Perinatal/Neonatal Casebook
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Perinatal/Neonatal Casebook

Neonatal Transport: A 3-Day-Old Neonate With Hypothermia, Respiratory Distress, Lethargy and Poor Feeding

Journal of Perinatology volume 22, pages 506–509 (2002)Cite this article

The neonatal transport team was called to transport a 3-day-old male infant who had stopped nursing and became jittery and hypothermic. He was born at 37 weeks' gestation to a 34-year-old gravida 3, para 2 mother; his birth weight was 2694 g. Mother's prenatal laboratory studies were blood type B+, VDRL-negative, Hepatitis B surface antigen–negative, rubella-immune and HIV-negative. Her pregnancy was uncomplicated. The presentation was vertex and the route of delivery was by Cesarean section with labor. APGAR scores were 9 at 1 minute and 9 at 5 minutes; he did not require cardiopulmonary resuscitation.

The patient did well until early on day of life 3 when he stopped nursing. He was supposed to be discharged to home later that day, but his father noted noisy breathing and grunting. Neonatology was consulted at this point in time. His physical examination was remarkable for hypertonia and jitteriness involving all four extremities. These movements could be stopped but would restart again. His rectal temperature was 36.5 °C. He had also lost 270 g since birth. His oxygen saturation was 96% while breathing room air. An arterial blood was obtained: pH 7.41, paCO2 26 mm Hg, paO2 95 mm Hg and a base excess of −6 (in room air). The blood pressure was noted to be elevated. Additional laboratory studies included: total bilirubin of 9 mg%, electrolytes including Na+ of 149 mEq/l, K+ of 6.9 mEq/l, Cl of 111 mEq/l, total Ca of 8.6 mg% and a glucose screen of >80 mg%. White blood cell count was 16,800, and hematocrit and platelet counts were 48% and 484,000, respectively. SGPT was 34 and a blood culture was drawn. A peripheral venous line was placed and the infant was started on 10% dextrose with electrolyte solution and, because of a low urine output, he was also given a bolus of 10 ml/kg 5% albumin. Ampicillin and gentamicin were started as well. By the time the neonatal transport team arrived, he required supplemental oxygen of 35% to 40%. His heart rate was 170 to 180 beats/min and his lungs sounded “wet” at that time. A chest radiograph showed borderline normal-sized heart and bilateral fluffy infiltrates in the lungs. He was also noted to have significant abdominal distention. An orogastric tube was placed and 5 ml of fresh blood was suctioned from the stomach. The baby was transported without difficulty. Upon arrival to the Neonatal Intensive Care Unit, an arterial blood gas was obtained and results included: pH 7.17, paCO2 55 mm Hg, paO2 of 147 mm Hg and a base deficit of −10. He was then intubated and was placed on a ventilator. It became evident that he had suffered a severe pulmonary hemorrhage. A plasma ammonia level of >2000 μM/l directed the diagnosis.

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  1. Department of Pediatrics, Evanston Hospital, 2650 Ridge Avenue, Evanston, IL, USA

    Monica Joseph MD & Joseph R Hageman MD

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  1. Monica Joseph MD
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  2. Joseph R Hageman MD
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Joseph, M., Hageman, J. Neonatal Transport: A 3-Day-Old Neonate With Hypothermia, Respiratory Distress, Lethargy and Poor Feeding. J Perinatol 22, 506–509 (2002). https://doi.org/10.1038/sj.jp.7210755

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