Clinico-Pathologic Conference: Congenital Hypomyelinating Neuropathy in Two Infants of a Triplet Birth

Abstract

The patients were identical twins, A and B, part of a triplet delivery to a 34-year-old G2 P1 mother whose pregnancy was the result of in vitro fertilization with two eggs. Although Baby C had decreased amniotic £uid, he appeared to be normal. The mother had a urinary tract infection at the time of delivery. Cesarian section was performed because of oligohydramnios in Baby C and possible polyhydramnios in Baby B. Estimated gestational age was 33 weeks. There was no history of maternal medications. Baby AThis male infant, born by Cesarian section, was the ¢rst-born of triplets and was the identical twin of Baby B. Apgar scores were listed as 8 and 9 at 5 and 10 min, respectively. Birth weight was 1915 g. Because of respiratory depression, the infant was intubated and given narcan. Ventilation was carried out with Fi0 2 of 0.21. Ca¡eine and aminophylline were administered, but ventilation could not be discontinued. Cranial ultrasound was reported as normal. Feedings were carried out with a 24-calorie-per-ounce formula.The infant was transported to the tertiary care center on day 11.At the tertiary center, ca¡eine was continued, until approximately 35 days of age. Fluoroscopy revealed poor movement of the diaphragms. MRI carried out on day 12 was normal, with normal brain stem. Sleep studies revealed increased