Case report: Tackling the complexities of an extremely premature newborn with intrauterine growth restriction and congenital metabolic disorders through a multidisciplinary approach

Ioana Roșca; Andrei Gheorghe Preda; Andreea Teodora Constantin; Ciprian Coroleucă; Emilia Severin; Raluca Ioana Teleanu; Alina Turenschi

doi:10.3389/fped.2023.1162226

Case report: Tackling the complexities of an extremely premature newborn with intrauterine growth restriction and congenital metabolic disorders through a multidisciplinary approach

Front Pediatr. 2023 Jun 19:11:1162226. doi: 10.3389/fped.2023.1162226. eCollection 2023.

Authors

Ioana Roșca^{1

2}, Andrei Gheorghe Preda¹, Andreea Teodora Constantin^{2

3}, Ciprian Coroleucă^{2

4}, Emilia Severin⁵, Raluca Ioana Teleanu^{2

6}, Alina Turenschi⁷

Affiliations

¹ Neonatology Department, Clinical Hospital of Obstetrics and Gynecology "Prof. Dr. P. Sârbu", Bucharest, Romania.
² Department of Pediatrics, Neonatology, and Specialized Care, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
³ Pediatrics Department, National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bucharest, Romania.
⁴ Obstetrics and Gynecology Department, Clinical Hospital of Obstetrics and Gynecology "Prof. Dr. P. Sârbu", Bucharest, Romania.
⁵ Department of Genetics, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
⁶ Pediatrics Department, Children's Clinical Hospital "Dr. Victor Gomoiu", Bucharest, Romania.
⁷ Pediatrics Medical Resident, Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Abstract

Background and objectives: The premature birth of a newborn can present a complex challenge for healthcare providers, particularly in cases of extreme prematurity combined with intrauterine growth restriction and multiple metabolic deficiencies. In this report, we aim to shed light on the difficulties and considerations involved in the management of such a case. In addition, our study is aimed to raise awareness of the importance of a multidisciplinary team in managing an extreme premature case with multiple comorbidities.

Case presentation and main findings: We present the case of a 28-week premature female newborn with very low birth weight (660 g, percentile <10%) and intrauterine growth restriction. She was born through emergency cesarean delivery due to maternal Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome and had a high-risk pregnancy (spontaneous twin pregnancy, with one fetus stopping development at 16 weeks and maternal hypertension). In the first hours of life, she presented with persistent hypoglycemia requiring progressive glucose supplementation up to 16 g/kg/day to maintain normal blood glucose levels. The baby then showed favorable progress. However, from days 24 to 25, hypoglycemia recurred and did not respond to glucose boluses or supplementation in both intravenous and oral feeds, leading to the suspicion of a congenital metabolic disorder. Endocrine and metabolic screenings led to suspicion of primary carnitine deficiency and a deficiency in hepatic form of carnitine-palmitoyltransferase type I (CPT1) on the second screening.

Conclusion and clinical implications: The study highlights rare metabolic anomalies that can be due to both organ and system immaturity and delayed enteral feeding and excessive use of antibiotics. The clinical implications of this study emphasize the need for careful monitoring and comprehensive care of premature infants to prevent and manage potential metabolic abnormalities by neonatal metabolic screening.

Keywords: L-carnitine deficiency; VLBW; extreme premature newborn; hypoglycemia; multidisciplinary approach.

Publication types

Case Reports