A nine-day-old baby girl passed away while receiving care in a neonatal intensive care unit. She was born via vaginal birth after eight hours of labor at 38-40 weeks of gestation and weighed 2.5 kg.  After the delivery, the baby experienced many issues, including paralysis of her lower body and an infection in her lungs, which progressed to meningitis. Her Apgar scores and 1 and 5 minutes after birth were 6 and 8, respectively. Other symptoms included failure to suck, fast breathing, gasping, and grunting. A physical exam showed gross abnormalities, including spina bifida, with obvious protrusion of the spinal cord. NICU staff administered ampicillin, gentamycin, cloxacillin, and phenobarbital and provided oxygen. After receiving the medications, the baby’s heart rate decreased to 16 beats per minute, a pulse could not be found, and CPR was done for 20 minutes. Sadly, the baby passed away approximately nine days after her birth due to multiple organ failure.

Uncovering the Cause

The mother of the neonate reported experiencing complications during the pregnancy. This issue was not addressed because the mother received no antenatal during her pregnancy. At 38-40 weeks of gestation, she went to a health center after experiencing a pushing-down feeling, which is a sign of labor. Upon arriving at the health center, she was referred to the hospital.

CHAMPS laboratories tested cerebrospinal fluid cultures and conducted other tests for malaria and HIV, all of which were negative. The blood culture and TAC results found Klebsiella pneumoniae and E. coli. The pathology results identified neutrophilic infiltration in the lung and brain tissue, supporting a bacterial infection in both organs.

Pathology Images 

Family Follow-Up 

 During the results communication session, the mother was given information about the causes of her baby’s death and education to prevent similar issues in future pregnancies. Early identification of neural tube defects during antenatal care (ANC) is advised, as in many cases, neural tube defects are caused by a lack of folic acid in the mother’s diet. If there are insufficient vitamins in the mother’s blood when she becomes pregnant, the baby is at risk of incomplete brain development; once pregnant, these birth defects are difficult to prevent or address. Spina bifida can be corrected after birth and does not necessarily cause death. However, most cases of spina bifida can be prevented if the mother gets enough folate before and during pregnancy. Health-seeking behavior, good nutrition, and early initiation of ANC help to prevent spina bifida and other neural tube defects in pregnancy.

Public Health Implications

Severe neural tube defects (NTDs) could be detected earlier in pregnancy, and pregnant mothers are advised to seek early and frequent ANC. Spina bifida causes hydrocephalus, an enlarged head in the baby, which can make vaginal delivery very difficult. With better ANC and early diagnosis of NTDs, mothers can plan their delivery or C-section to avoid intrauterine fetal distress. Neural tube defects are highly prevalent, especially in countries without folic acid fortification programs, and spina bifida is the most common clinical presentation. It is well known that folate deficiency in pregnant women has the potential to impact the prevalence of these neural tube defects, and then to avoid them, an adequate level of folic acid in the mother’s blood should be established at the time of conception. There is an urgency to implement effective programs to get all women of reproductive age to have adequate folic acid in their diet, which could potentially prevent up to 96% of spina bifida and anencephaly cases.

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