Neonatal brain abscess development following fetal scalp electrode placement: a rare complication

T Fick,P A Woerdeman

doi:10.1007/s00381-021-05150-7

Abstract

A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient developed a very large brain abscess after initial superficial infection of the skin site due to an FSE. The patient was admitted to the hospital after an asymmetric growth of the skull was noticed with no further signs of clinical illness. MRI showed a very large brain abscess which was aspirated and treated with antibiotics for 10 weeks. A 2-year follow-up showed only a slight developmental delay in gross motor skills. Only once before a similar case has been described at which the patient developed a brain abscess after superficial infection of the scalp following an FSE. In both cases, the brain abscess was noticed due to an asymmetric growth of the skull without any further signs of clinical illness. A brain abscess has a high mortality and morbidity rate, and early diagnosis is vital for the optimal outcome. We therefore recommend to organize an out-patient clinical follow-up for every infant with a superficial infection of the skin site after placement of an FSE.

Highlights

Cardiotocography (CTG) is a technique to monitor the fetal heart rate and uterine contractions during labor
A fetal scalp electrode (FSE) accounts for a more accurate measurement and is less affected by movement compared to external monitoring and is
We present a case of an 8-week old infant with a very large brain abscess due to placement of an FSE

Summary

Introduction

Cardiotocography (CTG) is a technique to monitor the fetal heart rate and uterine contractions during labor. A fetal scalp electrode (FSE) accounts for a more accurate measurement and is less affected by movement compared to external monitoring and is. A fetal scalp electrode for cardiotocography was indicated for monitoring due to oligohydramnios. The FSE left a small laceration which after a couple of days showed infection (Fig. 1). This was treated with fusidic acid cream 20mg/g for 5 days and led to a full recovery of the skin site. Post aspiration ultrasound imaging in the OR revealed a small abscess residual. Head circumference was measured daily, and ultrasound was planned 1 week after surgery. After 6 weeks, the patient was discharged from the hospital in good clinical condition.

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