Salih Aso Faeq, Jawad Ali M, Jawad Majeed H
Suleimani University, Sulaimaniyah, Iraq.
Anwar Sheikha Medical City, Sulaimaniyah, Iraq.
Glob Pediatr Health. 2024 Sep 9;11:2333794X241273204. doi: 10.1177/2333794X241273204. eCollection 2024.
We report a case of a neonate, delivered by C-section, that rapidly developed respiratory compromise and hemodynamic instability prompting admission to critical care. Urgent cardiology assessment with echocardiography revealed severe systolic dysfunction from localized myocardial ischemia and pulmonary hypertension. Their management progressively escalated, eventually requiring inotropic support. Despite intensive treatment and meticulous nursing with demonstrable improvement of cardiac function, they deteriorated suddenly and died on Day 2 post-partum. This case emphasizes the challenge in early recognition of neonatal shock due to often nonspecific presentations, with hemodynamic compromise arising later. We recommend close vigilance for deterioration, awareness of indolent etiology including viral myocarditis, titration of appropriate inotropes and synergistic adjunctive vasodilators, and consideration of immune modulators such as corticosteroids that addresses biochemical deficiencies and support cardiac function. Ultimately, aggressive, targeted, and multi-focal treatment, especially in resource-limited environments, maximizes the chances of survival in challenging clinical situations such as progressive neonatal shock.
我们报告了一例剖宫产分娩的新生儿病例，该新生儿迅速出现呼吸功能不全和血流动力学不稳定，随后被送入重症监护病房。通过超声心动图进行的紧急心脏评估显示，局部心肌缺血和肺动脉高压导致严重的收缩功能障碍。对其治疗逐步升级，最终需要使用强心药物支持。尽管进行了强化治疗和精心护理，心脏功能有明显改善，但该新生儿在产后第2天突然病情恶化并死亡。该病例强调了早期识别新生儿休克的挑战，因为其表现往往不具特异性，血流动力学损害出现较晚。我们建议密切监测病情恶化情况，了解包括病毒性心肌炎在内的隐匿病因，滴定使用合适的强心药物和协同辅助血管扩张剂，并考虑使用免疫调节剂，如皮质类固醇，以解决生化缺陷并支持心脏功能。最终，积极、有针对性和多方面的治疗，尤其是在资源有限的环境中，可在诸如进行性新生儿休克等具有挑战性的临床情况下最大限度地提高生存几率。
