Multifocal Multi-organ Ischaemia and Infarction in a Preterm Baby Due to Maternal Intravenous Cocaine Use: A Case Report

Ben C Reynolds; Dawn MK Penman; Allan G Howatson; Lesley A Jackson; Charles H Skeoch

J Med Case Reports. 2009;3:9324

Abstract and Introduction

Abstract

Introduction: Although the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use.
Case presentation: A Caucasian female baby of 29-weeks' gestation was spontaneously delivered and subsequently developed multi-organ failure considered unrelated to simple prematurity. Intensive care was re-orientated following the development of massive intraventricular haemorrhage.
Conclusion: This case illustrates the need for regular cranial ultrasound in babies of pregnancies at risk due to intravenous cocaine use and also the necessity of counselling women who misuse cocaine in the antenatal period. As such, this article will be of most interest to paediatric and obstetric staff.

Introduction

Cocaine use in pregnancy has been associated with adverse fetal outcomes including congenital malformations. We report a female baby of 29 weeks' gestation whose mother had extensive polydrug misuse throughout her pregnancy, including the use of intravenous cocaine. Following spontaneous delivery, the baby died after three days of intensive support. A post-mortem examination revealed widespread ischaemic change throughout multiple organs. We hypothesise that the unusual extent of this damage is related to the route of administration and dosage of cocaine during the pregnancy.

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Cite this: Multifocal Multi-organ Ischaemia and Infarction in a Preterm Baby Due to Maternal Intravenous Cocaine Use: A Case Report - Medscape - Dec 01, 2009.

Table 1. Temporal evolution of laboratory parameters.
Laboratory parameter		Age
Parameter	Reference Range	1 hour	12 hours	36 hours
PT	10.6–16.2 secs	54	29
APTT	27.5–79.4 secs	60	41
TCT	19.2–30.4 secs	23	19
Fibrinogen	1.5–3.73 g	0.5	1.2
Urea	2.5–7.5 mmol/l		6.4	9.5
Creatinine	35–100 μmol/l		78	136
Bicarbonate	21–28 mmol/l	22.0	15.6	13.1
AST	<40 U/l		1891	2168
ALT	<50 U/l		200	203
Gamma-GT	<55 U/l		259	227
Albumin	g/l		21	17

Stated coagulation reference ranges are applicable to 30-week gestation healthy controls on the first day of life.
ALT, alanine transaminase; APTT, activated partial thromboplastin time; AST, aspartate transaminase; Gamma GT, gamma glutamyl transferase; PT, prothrombin time; TCT, thrombin clotting time.

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