1. (Robbins 5th Ed. p. 432-436, 442-446, 1077-1078) or (Robbins 6th Ed. p. 460-464, 470-473, 1082, 1302)
2. Images 1-8 relate to this case, Images 9-12 show related topics
Baby Girl K. was delivered at 28 weeks gestation (calculated by mother's last menstrual period) to a 25-year-old woman with a history of pregnancy-induced hypertension and continued heavy tobacco use. The mother came to the clinic complaining of cramping and rupture of placental membranes for 24 hours. She had a fever of 39°C. The fetal heartbeat was irregular, indicative of fetal distress. Due to concerns about fetal well-being, the delivery was induced. The infant was delivered 4 hours later and weighed 600 grams; the Apgar scores were 4 at 1 minute and 7 at 5 minutes. The infant appeared long and thin, with a relatively enlarged head size. By measurements, the body weight and crown-heel length were consistent with 25 weeks gestational age, and the head circumference was consistent with 28 weeks gestation. The gestation was estimated by clinical maturity studies to be 28 weeks. Sternal retractions were noted, indicating respiratory difficulties, and artificial surfactant was given. The respiratory status did not improve, and the infant was placed on a ventilator. Blood cultures were drawn, and the infant was begun on antibiotics. Over the course of the next day, increasing ventilatory support was required. The chest radiograph is available for viewing (Image #1). Blood cultures returned positive for group B streptococcus. On the second day of life, seizures developed. A head ultrasound diagnosed a severe intraventricular hemorrhage. After a discussion with the parents it was decided that heroic measures would not be instituted, and the infant expired at 32 hours of age. An autopsy was done. Gross and microscopic photographs are represented in the images for Case 1.