LAUSR

1. Ellen McMahon, MD* 2. Abbey Freed, DO† 3. Melanie Rudnick, MD‡,§ 4. Mark H. Corden, MD¶,** 1. *Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN 2. †Division of General Pediatrics and 3. ¶Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 4. ‡Division of Hospital Medicine, Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT 5. §Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 6. **Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA A 2-week-old boy is referred to our institution for further evaluation of an intraventricular hemorrhage (IVH). He was born at 40 and 1/7 weeks' gestation weighing 3,535 g via cesarean delivery for failure to progress and nonreassuring fetal heart tracing to a 24-year-old gravida 1, para 1 mother with chorioamnionitis. Results of prenatal ultrasonography and maternal laboratory tests were normal. Apgar scores were 3 and 7 at 1 and 5 minutes, respectively. Continuous positive airway pressure was initiated for poor respiratory effort. He received supplemental oxygen until postnatal day 8 due to persistent tachypnea and clinical respiratory distress syndrome. Given an initial newborn sepsis risk score of 0.74, (1) which increased to greater than 3 with persistent hypothermia and a supplemental oxygen requirement, the patient received ampicillin and gentamicin for 48 hours, as well as acyclovir for 5 days. Cultures of blood, urine, and cerebrospinal fluid were all negative. The patient had a nonfocal neurologic examination. Because of recurrent episodes of hypothermia without a known infectious source, the neonatologist was concerned for a central cause of temperature dysregulation. Cranial ultrasonography was performed on postnatal day 2 demonstrating blood in the occipital horn of the left lateral ventricle, as well as asymmetrical left ventricular enlargement, concerning for IVH (Fig 1). Repeated cranial ultrasonography on postnatal days 6 and 11 demonstrated persistent asymmetry of the left lateral ventricle concerning for a choroid …