Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report.
Background
Cushing reflex
Intraventricular hemorrhage
Raised intracranial pressure
Tension pneumothorax
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
14 Dec 2021
14 Dec 2021
Historique:
received:
05
08
2020
accepted:
20
10
2021
entrez:
14
12
2021
pubmed:
15
12
2021
medline:
17
12
2021
Statut:
epublish
Résumé
The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5-6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses' recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure. While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.
Sections du résumé
BACKGROUND
BACKGROUND
The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease.
CASE PRESENTATION
METHODS
The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5-6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses' recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure.
CONCLUSION
CONCLUSIONS
While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.
Identifiants
pubmed: 34903289
doi: 10.1186/s13256-021-03161-1
pii: 10.1186/s13256-021-03161-1
pmc: PMC8670276
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
592Informations de copyright
© 2021. The Author(s).
Références
Singapore Med J. 2010 Oct;51(10):e166-8
pubmed: 21103805
Neurosurgery. 2006 Nov;59(5):1132-7; discussion 1137
pubmed: 17143247
J Pediatr. 1978 Apr;92(4):529-34
pubmed: 305471
J Pediatr. 2014 May;164(5):992-998.e3
pubmed: 24461786
Pediatrics. 1982 Feb;69(2):144-9
pubmed: 6799932
Neonatology. 2017;111(4):331-336
pubmed: 28073106
Biol Neonate. 1987;52(6):327-36
pubmed: 3435736
J Perinat Med. 2007;35(3):175-86
pubmed: 17480144
Can Med Assoc J. 1965 Feb 13;92:309-11
pubmed: 14243865
Br J Anaesth. 2005 Jun;94(6):791-9
pubmed: 15805143
Pediatrics. 1976 Aug;58(2):177-83
pubmed: 7768
AJP Rep. 2012 Nov;2(1):43-6
pubmed: 23946905