Multifocal multi-organ ischaemia and infarction in a preterm baby due to maternal intravenous cocaine use: a case report

Abstract

Introduction: Although the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use.

Case presentation: A Caucasian female baby of 29-weeks' gestation was spontaneously delivered and subsequently developed multi-organ failure considered unrelated to simple prematurity. Intensive care was re-orientated following the development of massive intraventricular haemorrhage.

Conclusion: This case illustrates the need for regular cranial ultrasound in babies of pregnancies at risk due to intravenous cocaine use and also the necessity of counselling women who misuse cocaine in the antenatal period. As such, this article will be of most interest to paediatric and obstetric staff.

Figure 1.

Bilateral blood casts of cerebral ventricles. Post-mortem pathological specimen demonstrating ‘cast’ formed by cerebral ventricles entirely filled with blood following massive intraventricular haemorrhage.

Figure 2.

A clear demarcation of healthy liver on the left, ischaemic liver centrally, and necrotic areas to the right. Postmortem pathological specimen of liver demonstrating zonal multifocal necrosis, with marked macroscopic necrosis visible on right side of specimen, healthy liver on left and a ‘border’ of ischaemic tissue between.