Extreme preterm neonate with fetal warfarin syndrome

A 25+3 week gestation male infant weighing 493 g was delivered via caesarean section for intrauterine growth restriction and abnormal Dopplers. The mother was on long-term thromboprophylactic warfarin 5 mg/day due to her prosthetic mechanical heart valve following childhood rheumatic fever. Once pregnancy was diagnosed, at 4+0 weeks’ gestation, warfarin was discontinued and low-molecular-weight heparin was started. Warfarin was recommenced at 12+1 weeks’ gestation after a small maternal stroke. Neonatal dysmorphic facial features were noted, most obviously nasal hypoplasia (figure 1). The hypoplastic upper airway precluded successive attempts to extubate to non-invasive ventilation. Radiographs showed stippled epiphyses and punctate calcifications paraspinally and in cartilaginous epiphyses (figure 2). Genetic investigations including chondrodysplasia punctata panel were negative.1 Fetal warfarin syndrome (FWS) is a rare condition resulting from fetal warfarin exposure during pregnancy. Presentation varies depending on dose and timing of exposure. Teratogenic effects of warfarin result...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - Category: Perinatology & Neonatology Authors: Tags: Images in neonatal medicine Source Type: research