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[Therapy refractory arterial hypotension after heart operation]
1Abteilug für Neonatologie, angeborene Storungen und Intersivmedizin, Universitätsklinik für Kinder- und Jugendheilkunde Wien.
Klinische Padiatrie
|January 1, 1997
Summary
Neonatal adrenal hemorrhage is a rare cardiac surgery complication. Prompt prednisolone treatment dramatically improved a neonate with transposition of the great arteries experiencing adrenal insufficiency.
Area of Science:
- Pediatric Cardiology
- Neonatalogy
- Endocrinology
Background:
- Adrenal hemorrhage is a rare but serious complication following neonatal cardiac surgery.
- Transposition of the great arteries is a congenital heart defect requiring surgical correction.
Observation:
- A neonate developed bilateral adrenal hemorrhage after arterial switch operation for transposition of the great arteries.
- Clinical presentation mimicked septic shock with severe hypotension, anuria, and hyperkalemia, unresponsive to catecholamines and sepsis treatment.
Findings:
- Adrenal insufficiency was diagnosed and treated with prednisolone, leading to dramatic clinical improvement.
- Diagnosis was confirmed by ultrasound and plasma cortisol/ACTH levels; insufficiency was transitory with normal sonography at 135 days.
- Pathogenetic factors may include cardiopulmonary bypass, anticoagulation, and perioperative stress.
Implications:
- Highlights the importance of considering adrenal insufficiency in neonates with shock-like symptoms post-cardiac surgery.
- Suggests a potential link between cardiopulmonary bypass, anticoagulation, perioperative stress, and adrenal hemorrhage.
- Emphasizes the need for early diagnosis and management of adrenal insufficiency to improve outcomes in critically ill neonates.