A rare case of cerebral hemorrhage in a pre-term infant with coarctation of the aorta

Introduction. Coarctation of the aorta (CoA) occurs in 6-8% of patients with congenital heart disease, with an incidence of 4/10,000 live births. It can be present with various clinical pictures, in an age range between newborn and adolescence. Infants with birth weights ≤ 2 kg with CoA have increased risk of severe intraventricular hemorrhage (IVH) compared to their birth weight-matched cohorts. Case presentation. We present a case of a premature, male newborn, with low birth weight, who at the age of 3 weeks developed signs and symptoms of cardiogenic shock. Clinical examination, echocardiography and angio-CT confirmed the diagnosis of a severe CoA, without any flow through the ductus arteriosus. Treatment with prostaglandin E1 was initiated, to promote ductal patency. The systolic blood pressures were above 99 percentile for his gestational age in the upper extremities, with a noninvasive pressure gradient around 86 mmHg between the arm and leg. Transfontanellar ultrasonography evaluation revealed a grade II/III bilateral IVH, in resorption, with cystic transformation. At the age of 6 weeks definitive surgical repair was performed. Postoperatively, at the 3 month follow-up, the clinical suspicion of recoarctation of the aorta arose, confirmed by echocardiography and angio-CT, with arterial hypertension and gradient around 37 mmHg between the arm and leg. Prosthetic patch aortoplasty was performed. The postoperative evolution was marked by the persistence of arterial hypertension, the infant requiring continued treatment with angiotensin-converting enzyme inhibitor. Conclusions. Premature neonates with low birth weight have always constituted a medical management challenge, with short and long term implications. A strong point in solving such cases is a multidisciplinary medical for assessment, management and outcomes.