Case 1: The Impact of Methylergometrin Maleate Toxicity on Neonates

Abstract

A full-term male neonate of 2.6 kg birthweight is born via a spontaneous vaginal delivery to a mother who denies any unfavorable obstetric or medical history. The delivery occurs at a peripheral hospital without any labor challenges. Approximately 20 minutes after delivery, the neonate develops central cyanosis and respiratory distress, for which he receives respiratory support in the form of oxygen through a nasal cannula. A decision is made to refer him to a tertiary NICU. On arrival at the NICU, lung auscultation reveals bilateral equal air entry, no adventitious sounds, subcostal and intercostal recessions, a respiratory rate of 70 breaths/min, and oxygen saturation above 95% in room air. Normal first and second heart sounds are heard, plus a systolic 3/6 murmur over the left upper sternal border; the heart rate is 155 beats/min, mean blood pressure is 60 mm Hg (75/50 mm Hg), and echocardiography shows an insignificant patent ductus arteriosus and small atrial septal defect secundum. The abdomen is soft and lax with no organomegaly detected. Neurologic examination shows lethargy, hypotonia, hyporeflexia of the deep tendon reflexes, and diminished primitive reflexes; the pupils are 2 mm in diameter with sluggish reaction to light bilaterally. Cranial ultrasonography depicts partially effaced ventricles as well as cerebrospinal fluid spaces denoting the possibility of …