CASE REPORT

Extremely Post-Term Infant with Adverse Outcome

Khalil Salameh, Rajai Al-Bedaywi, Lina Habboub, Naser Abulgasim Elkabir,
Ahmad Tomerak

Department of Pediatrics, Alwakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar

ABSTRACT

Post-term infants are born at a gestational age >42 weeks or 294 days from the 1st day of the last menstrual period. Post-term
infants have higher rates of morbidity and mortality than term infants. Risk factors for post-term births include the following:
Prim gravida, prior post-term pregnancy, and genetic predisposition as a concordance for post-term pregnancy is higher in
monozygotic than dizygotic twin mothers, maternal obesity, older maternal age, and male fetal gender. We are presenting a case
of newborn infant delivered at post-term 47 weeks (post conception age) who was born through thick meconium stained liquor
delivery showed sever skin peeling. He needed respiratory ventilation since birth and his brain magnetic resonance imaging
was abnormal. This report aims to raise awareness among obstetric-gynecology and neonatologists about complications of post
maturity and to put a plan to deliver these babies before reaching 42 weeks gestation

Key words: BW (Birth weight), CPAP ( continuous positive airway pressure), LSCS (lower section cesarean section), MRI
(magnetic resonance imaging), SGA (Small for gestation)

INTRODUCTION likely than term infants to have low Apgar scores, an indirect
measure of perinatal asphyxia.[5-7] Meconium aspiration,

T
he clinical presentation of post-term infants is based congenital malformations, and persistent pulmonary
primarily on fetal growth. In most cases, continued hypertension are also more frequently observed in post-
fetal growth results in higher birth weight (BW) in term infant.[6-8] In one autopsy study, post-term infants were
the post-term than term infant, with an increased likelihood more likely than control term infants to have evidence of
of macrosomia,[2-4] and post-term macrosomic infants are at aspiration of amniotic fluid and/or meconium, which may
risk for birth injury due to prolonged labor, cephalopelvic have contributed to respiratory failure and death.[9]
disproportion, and shoulder dystocia.

However, fetal growth restriction occurs in some post-term

CASE REPORT
infants, most likely caused by a poorly functioning placenta
We present a case of post-maturity-related perinatal morbidity
that is unable to provide adequate nutrition.[2-4] This results
with delivery at 47 weeks. No cause beyond post-maturity
in the birth of a small for gestational age (SGA) infant, who
usually appears malnourished. In these infants, the skin was found except that mother had a plan for elective lower
appears loose, especially over the thighs and buttocks, and segment cesarean section (LSCS) for previous LSCS, but
has prominent creases. Vernix caseosa is decreased or absent. mother neglected the date as she was afraid of the operation
Lanugo hair is sparse or absent, while scalp hair is increased. and wanted to wait until labor pains.
The nails typically are long. The infants generally have the
appearance of increased alertness and a “wide-eyed” look. This non-local expectant mother coming to Qatar from
Pakistan was 32 years old, gravida 5 para 4 (history of three
Both macrosomic and SGA post-term infants are at increased normal deliveries with fourth delivery as LSCS) gestational
risk for perinatal asphyxia.[2] Post-term infants are more diabetic on diet and with a history of good past health. This

Address for correspondence:

Khalil Salameh, Department of Pediatrics, Alwakra Hospital, Hamad Medical Corporation, Al Wakrah, Qatar.
Tel.: 0097440114258. E-mail: Ksalameh@hamad.qa
https://doi.org/10.33309/2638-7654.010208 www.asclepiusopen.com
© 2018 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license

Clinical Research in Pediatrics  •  Vol 1  • Issue 2  •  2018 43

 Salameh, et al.: Extremely post-term infant with adverse outcome

was unplanned pregnancy so unsure about the date, but mother Then i nfant was transferred to NICU, kept on mechanical
mentioned that LMP was on 16/3/2017, so plan was put by ventilation and during that period he got left side
gynecology doctors to do elective LSCS on 24/12/2018, but pneumothorax needed drainage [Figures 3 and 4], and
mother neglected that date. continue on mechanical ventilation for 2 days, His laboratory
result as initial simple blood tests and Metabolic screen test
Ultrasound examination done at 35 weeks showed normal were normal.
fetal growth.
On day 3, the infant had abnormal non-rhythmic movements
AT 47 weeks , she attended the obstetrics and gynecology of all extremity as convulsion which was aborted with one
emergency department with labor pain. She was admitted
dose of phenobarbitone. On day 9days of life Brain Magnetic
to the obstetrics ward, and a cardiotocogram showed fetal
resonance imaging was done and showed mild bilateral
distress in the form of fetal bradycardia and the liquor was
meconium stained., Baby was delivered by vacuum assisted symmetric diffusion restriction involving the posterior limb
vaginal delivery. With birth weight of 2475-g infant male of internal capsule, dorsal midbrain, and dorsal pons. Features
covered with thick meconium with severe skin peeling were reported as being in favor of metabolic encephalopathy
[Figures 1 and 2] with Apgar scores of 9/10 at 1 and 5 min, over hypoxic brain injury. During hospital stay infant had
respectively. Cord gas showed arterial PH 7.06 BE −11.3 feeding difficulty started orogatric tube feed until the 10th
PCO2 74 and venous PH 7.13 BE −11.8 PCO2 52 . At 5 min, day of life when he was discharged on full feed by sucking
the infant developed respiratory distress needed endotracheal with follow-up at the high risk baby clinic and pediatric
intubation and mechanical ventilation with oxygen of 40%. neurology clinic.

Figure 1: Staring eye Figure 3: Left pneumothorax

Figure 2: Skin peeling Figure 4: Drained left pneumothorax

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 Salameh, et al.: Extremely post-term infant with adverse outcome

DISCUSSION interval 1.1–1.8).[10] The prevalence of CP in children with a

GA >42 weeks was 1.44/1000 patients.
As the optimal intervention is the prevention of post-term
births, it has been suggested that induction of labor be routinely Epilepsy
performed in mothers who are at 41 weeks’ gestation. In a cohort Danish study, it appears that prolonged gestation
was a risk factor for early epilepsy that occurred within the
Nevertheless, there are settings in which induction of labor 1st year of life.[11]
at 41 weeks gestation is not an option. For these post-term
deliveries, the neonatal management consists of screening and However, there was no evidence of an association between
treating complications associated with prolonged pregnancy post-term delivery and epilepsy beyond 1 year of age.
(e.g., meconium aspiration, perinatal asphyxia, and persistent
pulmonary hypertension) and providing routine newborn care. Developmental outcome
• Before delivery, an assessment of the need for neonatal
resuscitation is made based on the GA, anticipated BW, In an older cohort study from 1977, post-term infants had
presence of a congenital anomaly or labor complications, comparable motor scores on the Bayley Scales of Infant
mode of delivery (e.g., cesarean delivery), and maternal Development at 8 months of age compared with controls, but
history. cognitive scores were lower.[12]
• Immediately after delivery, routine neonatal care is
provided which includes drying, clearing the airway Behavioral problems
of secretions if present, maintaining warmth, and a In a study of infants in the Netherlands, the risk of behavioral
rapid assessment of the infant’s clinical status based on problems and attention deficit disorder was increased among
vigor, including cry, heart rate, and tone, as well as an
post-term infants, compared with term counterparts.[13]
examination to identify any major congenital anomaly.

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How to cite this article: Salameh K, Al-Bedaywi R,
2010;304:976-82.
Habboub L, Elkabir NA, Tomerak A. Extremely Post-
12. Ehrenstein V, Pedersen L, Holsteen V, Larsen H, Rothman KJ,
Term Infant with Adverse Outcome. Clin Res Pediatr
Sørensen HT, et al. Postterm delivery and risk for epilepsy in
2018;1(2):43-46.
childhood. Pediatrics 2007;119:e554-61.

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