By Mindy Brudereck
This article is a part of the January/February 2018, Volume 30, Number 1, Audiology Today issue.
Case History
The 26-year-old mother was healthy throughout the term of the pregnancy and went into labor at 40-weeks' gestation. The pregnancy was complicated just prior to delivery with a possible abruption. There was significant bradycardia with the heart rate of the patient down to 40 beats per minute prior to delivery. This required a stat cesarean section.
At the delivery of the head, a deep scalpel injury occurred on the patient's scalp measuring about two centimeters in length for which stitches were required. After delivery, a large vasa previa was noted. Vasa previa occurs when fetal blood vessels from the placenta or umbilical cord cross the entrance to the birth canal, and can cause oxygen loss and bradycardia.
The patient did not cry at birth and had extremely poor perfusion with no activity and no respiratory effort. The patient was covered in a thick meconium and required suction and saline rinse of the mouth, nostrils, and nasopharynx, aspiration of the stomach, and chest physiotherapy. He was subsequently diagnosed with Meconium Aspiration Syndrome. The Apgar scores were two, five, and six, at one, five, and ten minutes, respectively.
Upon admission to the Neonatal Intensive Care Unit (NICU), umbilical arterial and venous catheters were placed immediately and the patient was given normal saline bolus to improve his blood gas. He was placed on nasal continuous positive airway pressure (CPAP). He had a sepsis workup performed and was started on ampicillin every 12 hours and gentamicin every 24 hours. The CPAP and antibiotics were discontinued after three days.
The patient was released from the NICU at five days old with no required follow-up. Prior to release, he passed his hearing screening in both ears at the 35-dB level.
This content is an exclusive benefit for American Academy of Audiology members.
If you're a member, log in and you'll get immediate access.
Member Login
If you're not yet a member, you'll be interested to know that joining not only gives you access to top-notch resources like this one, but also invitations to member-only events, inclusion in the member directory, participation in professional forums, and access to patient resources, tools, and continuing education. Join today!