AN INFANT WITH HEART FAILURE AND RESPIRATORY DISTRESS SYNDROME DELIVERED BY EMERGENT CESAREAN SECTION WITH PLACENTA PREVIA TOTALIS

Abstract

We report an infant with heart failure and respiratory distress syndrome (RDS) born by emergent cesarean section due to placenta previa totalis after massive vaginal bleeding. The patient was at 31 gestational weeks, and birth weight was 1785g. He was admitted to our neonatal intensive care unit due to respiratory failure and low birth weight. However, he also demonstrated severe heart failure. Blood pressure was 44/25 mmHg on admission and the low blood pressure continued following dopamine administra- tion. He was administered artificial pulmonary surfactant (S-TA) soon after admission, but respiratory failure did not sufficiently improve. In addition to dobutamine, S-TA was administered two more times, 6 and 16 hours after birth. Furthemore, in order to alleviate respiratory failure, high frequency oscillation was started at 16 hours. Then his general condition improved gradually and he was extubated 27 days after birth. In conclusion, infants delivered by emergent cesarean section due to placenta previa totalis with massive vaginal bleeding may demonstrate severe heart failure and require more intensive respira- tory and circulatory support than standard RDS infants.