Abstract
A full-term female newborn with neonatal asphyxia and severe anemia (Hb 2.5 g/dL) with normal heart developed a massive myocardial infarction. No examinations were performed during pregnancy for parental nomadism. The baby had immediate external cardiac massage, ventilatory assistance, and blood transfusion. Cardiomegaly was evident at chest X-ray and marked signs of ischemia-lesion at ECG. Echocardiography showed dilated, hypertrophic, and hypocontractile left ventricle (LV), mitral and tricuspid regurgitation, and moderate pericardial effusion. Rh isoimmunization and infective agents were excluded at laboratory tests. Despite the treatment with inotropes, hydrocortisone, and furosemide, the baby worsened and died at 45 hours of life. Postmortem examination showed diffuse subendocardial infarction of LV and diffuse parenchymal hemorrhages and myocardial hypertrophy, increase of eosinophilia, and polymorphonucleated cells at histology. Our patient suffered apparently from longstanding fetal anemia of unknown etiology that led to perinatal distress, severe hypoxia, and massive myocardial infarction, unresponsive to the therapy.
Highlights
The occurrence of myocardial infarction in newborns has been associated with cardiac malformations and abnormalities of the coronary arteries or thromboembolism [1]
We report a case of a full term newborn affected by neonatal asphyxia and severe anemia, with normal heart and coronary arteries anatomy, who developed a massive myocardial infarction
Echocardiography (Figure 1b) showed normal anatomy with the coronary arteries originated from the aorta; dilated and hypocontratile left ventricle (LV), with hypertrophic walls, mitral regurgitation, dilated right ventricle with tricuspid regurgitation and estimated pulmonary pressure of International Journal of Pediatrics
Summary
The occurrence of myocardial infarction in newborns has been associated with cardiac malformations and abnormalities of the coronary arteries or thromboembolism [1]. The syndrome of hypoxemia-related myocardial dysfunction in newborns occurs in about 30% of asphyxiated infants and is usually more relevant in preterm infants, due to immature myocardial contractility and respiratory distress syndrome [2]. Myocardial ischemia in full term infants with normal heart is an extremely rare and serious event. We report a case of a full term newborn affected by neonatal asphyxia and severe anemia, with normal heart and coronary arteries anatomy, who developed a massive myocardial infarction
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