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.