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Background <p>Metabolic alkalosis is characterized by increased pH (&gt; 7.45) and serum bicarbonate levels. In the early postnatal period, metabolic alkalosis is an uncommon problem, and its etiology is often due to maternal disorders. In the prenatal period, the mother’s hydroelectrolytic disorders can be transplacentally transmitted to the fetus; these alterations can seriously compromise the newborn’s health.</p> Case report <p>We report a case of a male infant born at home from an unknown pregnancy, with a gestational age estimated at 34&#xa0;weeks. The mother was unaware of her pregnancy and had not received prenatal care, giving birth in a non-medical setting. The infant was clinically stable upon arrival at the hospital; however, a blood gas analysis revealed hypochloremic metabolic alkalosis (pH 7.56; pCO2 43,7&#xa0;mmHg; Cl<sup>−</sup> 69&#xa0;mmol/L; Na<sup>+</sup> 117&#xa0;mmol/L; K<sup>+</sup> 3.8&#xa0;mmol/L; HCO3<sup>−</sup> 39&#xa0;mmol/L; SBE + 17.7&#xa0;mmol/L), which was also confirmed in subsequent tests and was similar to the mother’s electrolyte profile.</p> <p>The mother, who was severely underweight with a BMI of 16.5%, reported a history of vomiting, substance abuse (cannabis and cocaine), and hepatitis C. Due to the infant’s very low birth weight (1440&#xa0;g) and small-for-gestational-age status, the baby was admitted to the NICU. Initial treatment included respiratory support with high-flow nasal cannula and prophylactic caffeine therapy. No significant apnea episodes were noted, and the infant’s electrolyte disturbances were corrected with isotonic saline infusion, resulting in normalization of the acid–base and electrolyte balance within 72&#xa0;h.</p> <p>Following the resolution of metabolic alkalosis, the infant showed normal neurodevelopment and growth during the 2-year follow-up. The metabolic alkalosis observed in the infant was attributed to maternal hydroelectrolytic disturbances, likely exacerbated by malnutrition and substance abuse.</p> Conclusion <p>The case highlights the importance of a thorough maternal history, as transplacental electrolyte imbalances can lead to neonatal complications. Timely intervention in the neonatal period can prevent long-term developmental issues, as evidenced by the infant’s normal growth and neurodevelopment.</p> <p>In conclusion, neonatal metabolic alkalosis should be considered in the context of maternal health factors, and early intervention can mitigate potential short- and long-term risks. Further studies are needed to assess the long-term outcomes of such conditions and the optimal duration for follow-up.</p>

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Unexpected metabolic alkalosis in a newborn from denied pregnancy: case report

  • 期刊论文

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  • 发表日期：

    2025年7月17日

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  • Cusmano Carolina,
  • Bianco Carlo,
  • Cerasani Jacopo,
  • Boschero Marta,
  • Piceni Giorgia,
  • Alberto Ricotti

摘要

Background

Metabolic alkalosis is characterized by increased pH (> 7.45) and serum bicarbonate levels. In the early postnatal period, metabolic alkalosis is an uncommon problem, and its etiology is often due to maternal disorders. In the prenatal period, the mother’s hydroelectrolytic disorders can be transplacentally transmitted to the fetus; these alterations can seriously compromise the newborn’s health.

Case report

We report a case of a male infant born at home from an unknown pregnancy, with a gestational age estimated at 34 weeks. The mother was unaware of her pregnancy and had not received prenatal care, giving birth in a non-medical setting. The infant was clinically stable upon arrival at the hospital; however, a blood gas analysis revealed hypochloremic metabolic alkalosis (pH 7.56; pCO2 43,7 mmHg; Cl− 69 mmol/L; Na+ 117 mmol/L; K+ 3.8 mmol/L; HCO3− 39 mmol/L; SBE + 17.7 mmol/L), which was also confirmed in subsequent tests and was similar to the mother’s electrolyte profile.

The mother, who was severely underweight with a BMI of 16.5%, reported a history of vomiting, substance abuse (cannabis and cocaine), and hepatitis C. Due to the infant’s very low birth weight (1440 g) and small-for-gestational-age status, the baby was admitted to the NICU. Initial treatment included respiratory support with high-flow nasal cannula and prophylactic caffeine therapy. No significant apnea episodes were noted, and the infant’s electrolyte disturbances were corrected with isotonic saline infusion, resulting in normalization of the acid–base and electrolyte balance within 72 h.

Following the resolution of metabolic alkalosis, the infant showed normal neurodevelopment and growth during the 2-year follow-up. The metabolic alkalosis observed in the infant was attributed to maternal hydroelectrolytic disturbances, likely exacerbated by malnutrition and substance abuse.

Conclusion

The case highlights the importance of a thorough maternal history, as transplacental electrolyte imbalances can lead to neonatal complications. Timely intervention in the neonatal period can prevent long-term developmental issues, as evidenced by the infant’s normal growth and neurodevelopment.

In conclusion, neonatal metabolic alkalosis should be considered in the context of maternal health factors, and early intervention can mitigate potential short- and long-term risks. Further studies are needed to assess the long-term outcomes of such conditions and the optimal duration for follow-up.