PMC9904929_01
Clinical course immediately after birth. After birth, the patient underwent tracheal intubation and was mechanically ventilated. Systemic management with NO and catecholamines gradually improved OI and FiO2. At 5 days of age, NO was terminated, and CHD was started. Enteral nutrition started with breast milk at 4 days of age, but did not progress, so TPN gradually increased. PD catheter placement was performed at 11 days of age. At 18 days of age, CHD was switched to PD and extubated at 19 days of age. OI, oxygen index; PD, peritoneal dialysis; FiO2, fraction of inspired oxygen; NO, nitric oxide; CHD, continuous hemodialysis; TPN, total parenteral nutrition.
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The patient responded favorably to our treatment, and her best oxygen index (BOI) in the first 24 h improved from 14.7 to 3.5 (Figure 1). CHD and PD with mechanical ventilation (Figure 1). CHD was discontinued after successful water removal by PD, which was confirmed at 32 days of age. Enteral nutrition was provided from 4 days of age, and the patient was primarily managed by total parenteral nutrition (Figure 1).
Clinical course from birth to discharge. The patient was extubated at 18 days of age and was reintubated at 24 days of age due to CHF-caused poor water removal. After water removal by PD became stable, she was extubated at 36 days of age and respiratory support was performed by HFNC. Elemental diet (ELENTAL  P) was also used in addition to breast milk and low potassium medium phosphorus formula, but enteral nutrition did not progress, so an ED tube was inserted at 53 days of age. Nutrition gradually increased and was aided by the high-protein digestive nutritional supplement (PEPTAMEN STANDARD ). After removing the ED tube, nutrition encompassed breast milk and later switched to the low potassium medium phosphorus formula. The preparation concentration of low potassium medium phosphorus formula gradually increased from 15% to 18%. During the course, complications such as CRBSI, septic shock, and convulsion occurred but were controlled by treatment. BW, body weight; PD, peritoneal dialysis; CHF, congestive heart failure; CRBSI, catheter-related blood stream infection; HFNC, high-flow nasal canula; ED, elemental diet; CHD, continuous hemodialysis.
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After starting this nutritional supplement, the patient gained weight despite abdominal distension (Figure 2). The complications were successfully resolved through the administration of antibiotics, anticonvulsants, and antihypertensive drugs (Figure 2).
Head MRI. (a, b) T1-weighted MRI; (c, d) T2-weighted MRI. Parasagittal cerebral injury and ulegyria in the right parietal lobe and occipital lobe were observed. Arrows indicate parasagittal injury and circles indicate ulegyria.
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The brain MRI obtained on the 112th day showed lesions in the right parietal and occipital lobes, suggesting the development of symptomatic epilepsy (Figure 3).