Key result
Hydrocortisone is linked to the rapid resolution of circulatory collapse in neonatal pericardial effusion.
Why the study?
The etiopathogenesis, presentation, associated findings, natural course, and management of fetal and neonatal pericardial effusion in Down's syndrome are not completely understood and require further description.
Case Report (n=1)
May warrant adrenal insufficiency evaluation in hypotensive Down syndrome neonates; case report leaves open hydrocortisone efficacy.
weeks) male neonate with Down's syndrome (DS) diagnosed with isolated pericardial effusion (PE) at 20 weeks of gestation. He was born by precipitous delivery, needed no resuscitation and presented within first 24 hours of life with respiratory distress, anemia due to feto-maternal bleed, hypotension, hepatomegaly, and coagulopathy. Postnatal echocardiography confirmed a 5 mm rim of PE without tamponade, normal cardiac structure, and function. He was stabilized with ventilation, packed red cell, fresh frozen plasma, inotropes (dopamine, dobutamine, and adrenaline), and steroid (hydrocortisone). Subsequent evaluation confirmed hypothyroidism, transient myeloproliferative disorder (TMD), hepatic failure due to fibrosis/cirrhosis with portal hypertension, and steroid sensitive hypotension on two occasions possibly due to adrenal insufficiency. PE completely resolved over 2 weeks. In view of progressively worsening liver failure with ascites and portal hypertension, the family opted for palliation. Literature review has been discussed regarding perinatal onset of PE in DS.
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Pharande et al. (2018) conducted a case report in Down's syndrome with pericardial effusion (n=1). Hydrocortisone was evaluated on Resolution of circulatory collapse and pericardial effusion. In a neonate with Down's syndrome and isolated pericardial effusion, hydrocortisone administration was temporally associated with the resolution of severe hypotension and circulatory collapse.
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