Miocardiopatía hipertrófica en un recién nacido macrosómico hijo de madre diabética

Abstract

We present the case of a late preterm newborn, male, product of the third pregnancy, a mother with a personal history of obesity and for 1 year Diabetes type 2 who abandoned treatment in the last month, in addition to several episodes of vaginosis and tract infections urinary tract during gestational period that were treated on an outpatient basis, patient was born at 36.3 weeks of gestational age by last menstruation date (LMP). Cesarean section is performed due to fetal macrosomia, a cyanotic, flaccid newborn is received with weak respiratory effort, for which an early clamping of the umbilical cord is performed, he is transferred to a radiant heat cradle, dried and stimulated, a heart rate (HR) of 60 is obtained bpm, for which a neonatal resuscitation protocol was started with a positive response after two cycles of positive pressure ventilation (PPV), an anthropometric weight of 4310 grams, head circumference of 36 cm, height 53 cm was performed. APGAR values 4-6-8, maintains respiratory distress accompanied by tachypnea 80 bpm, central cyanosis, remote audible respiratory whimper, marked subcostal retractions, Downes Score of 6, for which nasal CPAP is placed and is admitted to the Neonatology service. The physical examination of a grade II / VI systolic murmur is noteworthy, so it is decided to consult the Pediatric Cardiology service, perform an echocardiogram that reports global hypertrophic cardiomyopathy secondary to maternal Diabetes, treatment with furosemide 1mg / kg once a day is instituted and propanolol 0.5 mg / kg every 12 hours. Patient remains in the Neonatology service for 20 days, definitive oxygen weaning is achieved, adequate oral tolerance, evaluation by Pediatric Cardiology, echocardiogram is carried out xiii

for control, finding favorable evolution, deciding discharge with treatment with furosemide1mg / kg orally once a day for 7 days and propanolol 0.5 mg / kg orally every 12 hours until your control with a specialist. Clinical evolution of the patient, interpretation of laboratory tests, treatment, in addition to a study of risk factors associated with the case, are analyzed, identifying critical points and improvement actions are proposed to reduce the prevalence of this pathology.