Congenital central hypoventilation syndrome associated with Hirschsprung's Disease: case report and literature review. 2016

Renata Lazari Sandoval, and Carlos Moreno Zaconeta, and Paulo Roberto Margotto, and Maria Teresinha de Oliveira Cardoso, and Evely Mirella Santos França, and Cristina Touguinha Neves Medina, and Talyta Matos Canó, and Aline Saliba de Faria
Hospital de Base do Distrito Federal (HBDF), Brasília, DF, Brasil; Universidade de Brasília (UnB), Brasília, DF, Brasil. Electronic address: rsandoval.med@gmail.com.

OBJECTIVE To report the case of a newborn with recurrent episodes of apnea, diagnosed with Congenital Central hypoventilation syndrome (CCHS) associated with Hirschsprung's disease (HD), configuring Haddad syndrome. METHODS Third child born at full-term to a non-consanguineous couple through normal delivery without complications, with appropriate weight and length for gestational age. Soon after birth he started to show bradypnea, bradycardia and cyanosis, being submitted to tracheal intubation and started empiric antibiotic therapy for suspected early neonatal sepsis. During hospitalization in the NICU, he showed difficulty to undergo extubation due to episodes of desaturation during sleep and wakefulness. He had recurrent episodes of hypoglycemia, hyperglycemia, metabolic acidosis, abdominal distension, leukocytosis, increase in C-reactive protein levels, with negative blood cultures and suspected inborn error of metabolism. At 2 months of age he was diagnosed with long-segment Hirschsprung's disease and was submitted to segment resection and colostomy through Hartmann's procedure. A genetic research was performed by polymerase chain reaction for CCHS screening, which showed the mutated allele of PHOX2B gene, confirming the diagnosis. CONCLUSIONS This is a rare genetic, autosomal dominant disease, caused by mutation in PHOX2B gene, located in chromosome band 4p12, which results in autonomic nervous system dysfunction. CCHS can also occur with Hirschsprung's disease and tumors derived from the neural crest. There is a correlation between phenotype and genotype, as well as high intrafamilial phenotypic variability. In the neonatal period it can simulate cases of sepsis and inborn errors of metabolism.

UI MeSH Term Description Entries
D007040 Hypoventilation A reduction in the amount of air entering the pulmonary alveoli. Hypoventilations
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D008297 Male Males
D006627 Hirschsprung Disease Congenital MEGACOLON resulting from the absence of ganglion cells (aganglionosis) in a distal segment of the LARGE INTESTINE. The aganglionic segment is permanently contracted thus causing dilatation proximal to it. In most cases, the aganglionic segment is within the RECTUM and SIGMOID COLON. Aganglionosis, Colonic,Colonic Aganglionosis,Megacolon, Congenital,Aganglionic Megacolon,Aganglionosis, Rectosigmoid Colon,Aganglionosis, Total Colonic,Congenital Intestinal Aganglionosis,Congenital Megacolon,Hirschsprung's Disease,Megacolon, Aganglionic,Rectosigmoid Aganglionosis,Total Colonic Aganglionosis,Aganglionosis, Rectosigmoid,Disease, Hirschsprung,Disease, Hirschsprung's,Hirschsprungs Disease,Rectosigmoid Colon Aganglionosis
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D020182 Sleep Apnea, Central A condition associated with multiple episodes of sleep apnea which are distinguished from obstructive sleep apnea (SLEEP APNEA, OBSTRUCTIVE) by the complete cessation of efforts to breathe. This disorder is associated with dysfunction of central nervous system centers that regulate respiration. Apnea, Sleep, Central,Central Sleep Apnea,Hypoventilation, Central Alveolar,Ondine Syndrome,Sleep-Disordered Breathing, Central,Apnea, Central,Apnea, Central Sleep,Central Alveolar Hypoventilation Syndrome,Central Sleep Apnea Syndrome,Central Sleep Apnea, Primary,Central Sleep Apnea, Secondary,Central Sleep Disordered Breathing,Newborn Primary Sleep Apneas,Primary Central Sleep Apnea,Primary Sleep Apneas of Newborn,Secondary Central Sleep Apnea,Sleep Apnea, Lethal Central,Sleep Apnea, Newborn, Primary,Alveolar Hypoventilation, Central,Alveolar Hypoventilations, Central,Apneas, Central,Apneas, Central Sleep,Breathing, Central Sleep-Disordered,Breathings, Central Sleep-Disordered,Central Alveolar Hypoventilation,Central Apnea,Central Apneas,Central Sleep Apneas,Central Sleep-Disordered Breathing,Central Sleep-Disordered Breathings,Hypoventilations, Central Alveolar,Sleep Apneas, Central,Sleep Disordered Breathing, Central,Sleep-Disordered Breathings, Central

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