Hanan Said Mohamed Yousef
King Khaled Military City Hospital Hafar AL Btin, Saudia Arabia.
Abstract Title:
Successful Survival of An Extreme Preterm 27-Weeker, 650 Grams Extremely Low Birth Weight Neonate with Respiratory Distress Syndrome, Citrobacter koseri Sepsis, and Clinical Necrotizing Enterocolitis in A Level ll Neonatal Intensive Care Unit. A Case Report.Biography:
M.D. Pediatrics (Suez Canal University) Fellowship Pediatric Hematology. Kummamoto University-Japan. Assistant Professor & Consultant of Pediatrics and Neonatology King Khaled Military City Hospital-Northern Area Armed Forces Hospital. KSA. Suez Canal University Hospital, College of Medicine Ismailia) Egypt.
Research Interests:
Background: Survival of extremely low birth weight (ELBW) infants remains challenging in low-resource settings because of the high incidence of respiratory and infectious complications. We report the successful survival of a 27weeker, 650 grams male Neonate managed in a regional hospital despite respiratory distress syndrome, Citrobacter koseri sepsis, and clinical necrotizing enterocolitis.
Case Presentation: A male neonate was delivered Through emergency cesarean section at 27 weeks plus 2 days gestation. He was born to A 29 years Old Mother Gravid 3 Para 1+1,She Received Full Course of Dexamethasone on Admission. She Had severe antepartum hemorrhage and Doppler Study Showed: Moderate insufficient fetomaternal flow. She Went Through Emergency cesarean section due to Severe preeclampsia. She was given oral Aldomet and Intravenous Magnesium Sulphate two Doses. The Baby was born flat with no spontaneous breathing, The baby was intubated immediately by 2.5 cm ETT Tube Using 00 Blade laryngoscope and fixed at 6 cm position and was confirmed by CO2 Detector, chest rising and improving Heart rate, APGAR Score was 3 at 1 minute and 8T at 5 minutes ,The baby was connected to mechanical ventilator PC-AC mode of ventilation with volume guarantee VT:50/minute, Tidal Volume 2.8 liter per minure,Peep:5,FIO2:30%UVC size 3.5 cm was inserted and fixed at 7cm,UAC size 3.5 was fixed at 12 cm, Survanta 4 mls Through ETT Tube was Given ,Birth weight was 650 Grams.Length;29 cm, Head Circumference:22Cm,chest circimfernece;19 cm. The infant developed respiratory distress syndrome requiring mechanical ventilation for 24 hours and received beractant (Survanta®). Following extubation, respiratory support was continued with CPAP for one week. During hospitalization, blood culture grew Citrobacter koseri, and the infant was treated successfully with targeted antimicrobial therapy. He subsequently developed clinical necrotizing enterocolitis, which responded to conservative medical management. Following comprehensive neonatal care, the infant achieved satisfactory growth and clinical recovery. After a 96-day NICU stay, he was discharged home weighing 1,850 grams.
Conclusion This case demonstrates that survival of extremely premature A 27-weeker ELBW Neonate complicated by gram negative sepsis of Citrobacter koseri sepsis and clinical necrotizing enterocolitis is achievable in A level ll Neonatal Intensive Care unit through timely respiratory support, surfactant therapy, infection management, nutritional support, and dedicated multidisciplinary neonatal care.
Learning Points
• Survival of a 650 grams infant born at 27 weeks is possible in a resource-limited regional hospital.
Early antenatal corticosteroids, surfactant administration, and brief mechanical ventilation contributed to favorable respiratory outcomes.
• Prompt diagnosis and treatment of Citrobacter koseri sepsis can result in successful recovery even in extremely preterm infants.
• Conservative management of clinical NEC can be effective when instituted early.
• Basic evidence-based neonatal care can substantially improve outcomes in low-resource settings.
• Keywords: Extremely preterm infant, Extreme Low Birth Weight. Gram Negative sepsis-Citrobacter Koseri, Necrotizing Enterocolitis.