Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report

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: The 1.94 kg Caucasian infant was delivered by caesarean section fo...

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Autores principales: Rothberg, Alan D., Smith, Johan, Lubbe, Welma
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670276/
https://www.ncbi.nlm.nih.gov/pubmed/34903289
http://dx.doi.org/10.1186/s13256-021-03161-1
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author Rothberg, Alan D.
Smith, Johan
Lubbe, Welma
author_facet Rothberg, Alan D.
Smith, Johan
Lubbe, Welma
author_sort Rothberg, Alan D.
collection PubMed
description 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: 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: 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.
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spelling pubmed-86702762021-12-15 Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report Rothberg, Alan D. Smith, Johan Lubbe, Welma J Med Case Rep Case Report 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: 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: 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. BioMed Central 2021-12-14 /pmc/articles/PMC8670276/ /pubmed/34903289 http://dx.doi.org/10.1186/s13256-021-03161-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Rothberg, Alan D.
Smith, Johan
Lubbe, Welma
Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report
title Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report
title_full Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report
title_fullStr Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report
title_full_unstemmed Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report
title_short Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report
title_sort evidence of an active cushing reflex in a preterm neonate with hyaline membrane disease: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670276/
https://www.ncbi.nlm.nih.gov/pubmed/34903289
http://dx.doi.org/10.1186/s13256-021-03161-1
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