Case presentation
This study was conducted according to the Declaration of Helsinki principles. Also, CARE guidelines and methodology have been followed. A 5 days’ new born boy with 3300 g birth weight with seizure, frequent apnea, rise in ammoniac and lactate blood and reveal meconium aspiration as chief complaint was referred from the parturition center to our neonatal intensive care unit (Bu Ali Sina Hospital, Sari, Mazandaran Province, Iran). His mother suffered from schizophrenia, major depression and anxiety disorder that treated with risperidone, quetiapine, sertraline and clonazepam. In COVID-19 quarantine period and fear of infection, she imagines infected with covid-19 and decides to suicide with her medicines, whereas was in the last month of pregnancy and near of delivery. However, she wasn’t successful because of immediately medical intervention. She visited an obstetrician /gynecologist for her pregnancy follow up and decided to termination of pregnancy. After delivery, the newborn baby suffered from recurrent seizures and apnea. In pervious center, physician use phenobarbital to treat new born seizure and referred him to us. Primary lab tests including BUN, Cr, blood sugar, calcium, Total bilirubin, Direct bilirubin, K, Na, CRP, arterial blood gas(ABG), were requested. All these tests show normal situation except direct bilirubin and ABG results (Table.1). The increase in direct bilirubin level was attributed to neonatal icterus and frequent apnea can cause ABG abnormality. Patient scheduled for ultrasonography and echocardiography. The results of brain sonography showed 2.7 (mm) choroid plexus and an absorbing germinal matrix hemorrhage (Fig.1). Also, in abdominopelvic sonography revealed undescended testis (UDT), unilateral hydronephrosis in left kidney with 7/6 diameter. Nephrologist and endocrinologist consult requested. The echocardiography demonstrates atrial septal defect (ASD), patent ductus arteriosus (PDA), and mild tricuspid regurgitation (TR). MRI results reveal temporoparietal lesion in imaging (Fig.2). After all these examination and evaluation; phenytoin for his seizure, meropenem with amikacin for meconium aspiration and caffeine for apnea were perescripted. Phenytoin prevent seizures and it doesn’t repeat again. But five days after phenytoin started, dermatologic side effects including generalized rash, redness and maculopapular lesions were observed. So, phenytoin discontinued and exchanged to levetiracetam syrup 0.5 ml twice per day. Dermatologic consult was requested and topical Hydrocortison and Eucerin was prescribed. This treatment was useful and rashes vanished in next five days. Endocrine evaluation demonstrated no pathology, and total T4, free T4, TSH and blood sugar were in normal range. Eventually, after two weeks, patient was discharged from hospital and scheduled for refer to neurology, nephrology and cardiac clinic for treat his defects and follow up. In follow up checkup and evaluation of patient after five months, left upper limb was accompanied with little paresthesia with no more adverse effect.