CLINICAL HISTORY
A Caucasian baby girl was born at 37 weeks gestation by NSVD with Apgar Scores of 8 and 9 at 1 and 10 minutes with a birth weight of 2660 g to a 40-year-old G5P4004 woman. Prenatal serologies were negative. The pregnancy was complicated by gestational diabetes at 32 weeks requiring insulin treatment. At one hour of life, the infant had a dusky spell requiring stimulation and oxygen. Blood glucose determined by accucheck was 25 mg/dl which was treated by a dose of dextrose water. The spells recurred three hours later, and the infant was placed on intravenous D10. She had no other hypoglycemic episodes and began oral feedings. On the third day of life, the infant developed abdominal distension and tenderness and bloody stools. KUB showed air in the bowel wall. The infant developed apnea and required mechanical ventilation. The abdomen became more firm, and a second KUB showed free air in the abdomen. Exploratory laparotomy revealed perforated necrotic bowel, and ileostomy with colectomy was performed. Peritoneal fluid was cultured. Several hours postoperatively, the infant's status derteriorated acutely, and she expired.
LABORATORY DATA
Peritoneal Fluid Cultures: moderate colonies of C. tertium, C. perfringens, and coagulase-negative staphylococcus.
GROSS PATHOLOGY
Dusky brown large intestine (Figure 1) with yellow/tan areas of necrosis on the luminal surface.
MICROSCOPIC PATHOLOGY
Mucosal necrosis (Figure 2), transmural inflammation, and pneumatosis intestinalis of the colon (Figure 3). Higher magnification of pneumatosis intestinalis (Figure 4). Auerbach's plexus with ganglion cells in the rectum.
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