A Case Report of Severe Neonatal Complications and Outcomes Following Cardiac and Renal Pathologies

A 26-day-old term girl, weighing 3.3 kg and with a previously normal antenatal history, suddenly developed lethargy, rapid heartbeat, and seizures, necessitating ventilation. Initial evaluations for sepsis and metabolic issues yielded normal results. An ECG revealed narrow complex tachycardia that responded to synchronized cardioversion, leading to the initiation of metoprolol and digoxin for ongoing treatment. An echocardiogram indicated severe dysfunction in both ventricles, along with significant mitral and tricuspid regurgitation and a myxomatous mitral valve. 

A Doppler ultrasound of the brain showed increased blood flow with left cortical hyperintensities, and an MRI confirmed a left middle cerebral artery (MCA) infarct. An abdominal ultrasound uncovered a cystic lesion in the kidney, which a subsequent CT scan identified as a 2.2 × 4.1 × 3.4 cm solid cystic mass in the left posterior perinephric space, adjacent to the upper pole of the left kidney, with a hyperdense solid component and a small calcification, suggesting neuroblastoma. Urinary levels of vanillylmandelic acid were normal and a fine needle aspiration biopsy did not provide conclusive results. However, a frozen section revealed tumor cells with spindle and round morphology indicative of malignancy, prompting a total nephrectomy. The postoperative biopsy diagnosed hemangioma with adjacent cystic nephroma. At two months old, she was readmitted in shock with ventricular tachycardia and underwent aortic valve repair after stabilization. Unfortunately, she later succumbed to renal failure.

This case highlights the need for thorough assessments of neonatal health, including ultrasound evaluations of various organs. The severe mitral regurgitation and ventricular arrhythmia may have contributed to the stroke. The question of whether earlier mitral valve repair could have avoided the fatal outcome is debatable. The researchers considered genetic testing to explore the various conditions associated with the cystic nephroma, but the parents declined. The infant’s single functioning kidney may have led to her inability to tolerate surgery, resulting in her death from renal failure.

Source: Panigrahi N, Venkatesh H, Reddy VR et al. Neonatal Supraventricular Tachycardia– The Bedside Ultrasound Unearths Hidden Bullets. Indian J Pediatr. 2025. https://doi.org/10.1007/s12098-025-05444-7