Clinical Case Study: aEEG Monitoring on Infant with Perinatal Stroke

Dr. Linda van Rooij, Department of Neonatology

Clinical Case Study

A female infant born at 38+4 weeks gestation with a birth weight of 3170 grams. The mother was G1P0. She was admitted for induction at 38+4 weeks gestation because of pregnancy induced hypertension. On rupture of the membranes there was blood loss and on CTG a fetal tachycardia was seen. An emergency caesarean section was performed and during the resuscitation the infant had profound bradycardia with no spontaneous breathing effort. After 5 inflation breaths the heart rate increased and after 10 minutes she was breathing spontaneously but with an irregular breathing pattern. Apgar scores were 2, 5 and 7 at 1, 5 and 10 minutes respectively. She was admitted to the neonatal unit in an outlying hospital where she stabilized quickly. Her first glucose level was 3.6 mmol/L and she had a capillary sample lactate of 11.2 mmol/L. Around 12 hours after birth she had an incident of bradycardia, followed by a drop of oxygen saturation and thereafter clinical seizure like activity involving both arms and legs. A loading dose of phenobarbitone (20 mg/kg) was given. Ten hours later she developed clinical seizures again with movements of her right arm and a drop in oxygen saturation. Another dose of phenobarbitone was given and she was transported to our NICU for further cerebral monitoring and investigation.