From 22:30 to 23:45, the FHR was 150 to 160 with minimal variability. A vaginal exam done at 22:50 showed 0/50/-2 and the membranes were intact. The patient was taken to an operating room (OR) at 23:57 for cesarean delivery with a preoperative diagnosis of non-reassuring FHR tracing and intrauterine growth restriction (IUGR). Her male infant weighed 1800 g and had Apgars of 2, 3, and 7. Per the operative report, “a hand was placed into the incision and the vertex of the infant delivered with the assistance of a vacuum. With gentle traction and the assistance of fundal pressure the rest of the torso was delivered.”
The infant emerged limp and apneic without cry. Positive pressure ventilation (PPV) was administered in the transitional nursery. The heart rate was initially in the 70s and remained there. With PPV via the bag-mask, the infant’s heart rate gradually increased. The infant did not appear dysmorphic with spontaneous activity and respirations. The umbilical arterial cord gas was 6.96 and PCO2 greater than 87 with a base deficit of -8. The UVC cord gas was 7.08 with a base deficit of -9.5. The infant was to be admitted to the Neonatal Intensive Care Unit as he was described to be in critical condition. Ampicillin and gentamicin were initiated, and he was to be followed closely for evidence of end-organ injury or insult.
On August 22, 2015, the infant presented for neurology evaluation. He had previously seen a neurologist but his mother wanted a second opinion. At age 2 years, he still could not walk, sit, or pull to stand. He was weak on the left side and was found to have global developmental delay, presumably caused by prepartum and/or peripartum abnormalities of gestation. Through early intervention, he was receiving physical, speech, and occupational therapy services. A psychological evaluation had not yet been performed. Assessment was spastic infantile paralysis. Magnetic resonance imaging of the brain without contrast performed on August 28, 2015 showed gliotic signal abnormality in the bilateral centrum semiovale and corona radiate with mildly diminished supratentorial white matter volume, compatible with periventricular leukomalacia.
In case you missed it: The importance of intervention: When was this baby in trouble?
On September 1, 2016, the infant presented to speech pathology for an initial evaluation of dysphagia. Active problems included abnormal gait, asthma, chronic vomiting, constipation, hypospadias, penoscrotal hypospadias, poor weight gain, and spastic quadriplegic cerebral palsy. The impression was that the infant had mild-moderate oropharyngeal dysphagia characterized by reduced management of oral secretions with pooling of saliva on labial surface.