Contributed by Karen K. Deal, M.D. Ph.D., Ileana Lopez-Plaza M.D. and Margaret V. Ragni, M.D, M.P.H.
Published on line in September 1997
The patient is an African-American male neonate, one product of a 36-week fraternal twin gestation born to a 28-year old gravida 6, para 5 woman. The patient was a footling presentation, and vaginal delivery was difficult. He weighed 6 lb. 4 oz. at birth. Apgar scores were not available. He was subsequently discharged in good health on day 2 of life. On day 4 of life, the mother took the child to the pediatrician, having noticed oozing around the circumcision site. Later that same day, the mother noted that the child was lethargic and had poor intake. She brought the child to an outside Emergency Department. While in triage, the child was noted to have a generalized seizure and, shortly thereafter, went into respiratory and cardiac arrest. He was intubated and emergently transferred to Children's Hospital with CPR in progress. A normal cardiac rhythm was obtained, and the child was admitted directly to the Neonatal Intensive Care Unit.