Massive myocardial infarction in a full-term newborn: a case report

Area of Science:

• Neonatal cardiology
• Fetal medicine
• Pediatric pathology

Background:

• Neonatal asphyxia and severe anemia (Hb 2.5 g/dL) in a full-term newborn.
• Absence of prenatal examinations due to parental nomadism.
• Normal cardiac status prior to presentation.

Observation:

• Massive myocardial infarction developed shortly after birth.
• Clinical presentation included cardiomegaly, ischemic ECG changes, dilated/hypertrophic/hypocontractile left ventricle, valvular regurgitation, and pericardial effusion.
• Exclusion of Rh isoimmunization and common infectious agents.

Findings:

• Diffuse subendocardial infarction of the left ventricle and parenchymal hemorrhages observed postmortem.
• Histology revealed myocardial hypertrophy, eosinophilia, and polymorphonuclear cell infiltration.
• The condition was attributed to longstanding fetal anemia of unknown etiology.

Implications:

• Severe fetal anemia can precipitate perinatal distress, hypoxia, and fatal myocardial infarction in neonates.
• This case underscores the importance of prenatal diagnostics, even in cases of parental nomadism.
• Highlights the limited therapeutic options for severe neonatal myocardial infarction secondary to fetal anemia.