Severe perinatal dengue hemorrhagic fever in a low birth weight infant

A 31-year-old Hmong (Thai hilltribe) multiparous (G5P2) female with dengue hemorrhagic fever delivered a low birth weight male infant at 34 weeks estimated gestational age. The mother had fever for a total of 6 days, along with hepatomegaly, hepatic dysfunction and thrombocytopenia. Serology showed acute secondary dengue infection. She had no serious complications. The infant (birth weight 1,850 grams) developed a fever 140 hours postpartum of 37.8 degrees C for one day, then developed drowsiness, poor feeding and apnea. Hepatomegaly, thrombocytopenia, hepatic dysfunction and moderate coagulopathy were detected, with consequential shock and anemia due to gastrointestinal and pulmonary hemorrhage. Vigorous treatment with mechanical ventilation, packed red cells (PRC), fresh frozen plasma (FFP) and platelet concentrate transfusions were given and the child recovered successfully and commenced breast-feeding. At six months of age the child's growth and development were normal except for an impaired hearing screening test.