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BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0500. Epub 2009 Mar 17.

Arrival and survival of a 3-week-old boy from Pakistan with an arterial oxygen saturation of 17%.

BMJ case reports

Georg Hansmann, Felix Haas, Masood Sadiq, Michael Brook, Hans Peter Gildein

Affiliations

  1. Department of Cardiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts 02115, USA.

PMID: 21686777 PMCID: PMC3030105 DOI: 10.1136/bcr.07.2008.0500

Abstract

In newborn infants, acute perinatal hypoxic/ischaemic events and associated hyperoxia/reperfusion injury frequently lead to devastating neonatal brain damage. The present report concerns a 3-week-old boy from Pakistan with d-transposition of the great arteries (d-TGA), prolonged and severe hypoxaemia, and multiresistant bacterial sepsis. The term newborn infant underwent public airline transportation to Europe and presented on the airport's runway with severe hypoxaemia (pulsoximetric oxygen saturations (SpO2) 17%) and systemic hypotension. The patient eventually underwent late balloon atrial septostomy, followed by a successful two-stage arterial switch operation. A clinical follow-up 3-5 years later revealed lack of cerebral dysfunction, adequate neurodevelopment, good biventricular function, regular coronary flow, as well as normal ECG, blood pressure and SpO(2). The findings may indicate the neonatal brain adjusts better to chronic, slowly worsening hypoxia than to acute hypoxia (eg, "birth asphyxia"), and also suggests a greater tolerance for chronic hypoxia in neonates vs adults.

References

  1. J Pediatr. 2003 Mar;142(3):240-6 - PubMed
  2. Images Paediatr Cardiol. 2006 Jan;8(1):8-14 - PubMed
  3. Pediatrics. 2007 May;119(5):912-21 - PubMed
  4. Circulation. 2004 Sep 28;110(13):1743-6 - PubMed
  5. Trends Neurosci. 2003 May;26(5):248-54 - PubMed
  6. N Engl J Med. 2007 Nov 8;357(19):1971-3 - PubMed
  7. Circulation. 1999 Mar 9;99(9):1209-14 - PubMed
  8. Lancet. 2004 Oct 9-15;364(9442):1293-4 - PubMed
  9. Circulation. 2006 Jan 17;113(2):183-5 - PubMed
  10. N Engl J Med. 2005 Oct 13;353(15):1574-84 - PubMed
  11. Lancet. 2003 Sep 27;362(9389):1028-37 - PubMed
  12. Circulation. 2006 Jan 17;113(2):280-5 - PubMed
  13. N Engl J Med. 2007 Nov 8;357(19):1928-38 - PubMed
  14. Neurobiol Dis. 2007 Apr;26(1):243-52 - PubMed
  15. Biol Neonate. 2001;79(3-4):261-7 - PubMed
  16. Resuscitation. 2008 Jul;78(1):7-12 - PubMed
  17. Cardiol Young. 2006 Sep;16 Suppl 3:117-24 - PubMed
  18. Neurosci Lett. 1993 Dec 12;163(2):135-7 - PubMed
  19. Stroke. 1999 Sep;30(9):1851-4 - PubMed
  20. Pediatrics. 2008 Mar;121(3):648-9; author reply 649-50 - PubMed
  21. Ann Thorac Surg. 1984 Nov;38(5):438-43 - PubMed
  22. Am J Respir Crit Care Med. 2005 Dec 1;172(11):1393-8 - PubMed
  23. N Engl J Med. 2004 Nov 4;351(19):1985-95 - PubMed
  24. Pediatr Rev. 2007 Apr;28(4):123-31 - PubMed

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