Case Report The Successful Resuscitation in a Neonate with Down Syndrome after 45 minutes: A Case Report Mahin Seyedhejazi 1 , Maryam Haghighat Azari 2 , Nasrin Taghizadieh 3 , Haleh Farzin 2 * 1 Department of anesthesiology, Full professor of pediatric anesthesiology, Pediatrics teaching Hospital, Tabriz University of medical sciences, Iran 2 Department of anesthesiology, Assistant of Anesthesiology, Pediatrics teaching Hospital, Tabriz University of medical sciences, Iran 3 Department of anesthesiology, Medical student, Pediatrics teaching Hospital, Tabriz University of Medical sciences, Iran Corresponding Author: Haleh Farzin, E-mail: farzin.haleh@gmail.com ABSTRACT Introduction: Patients with Down syndrome (DS due to relative macroglossia and dynamic airway collapse) are vulnerable to signifcant upper airway complications. Obstructive sleep apnea (OSA) is a common condition and noted in about 79% of these children . Children with OSA, with or without DS, are sensitive to respiratory depression by drugs such as sedatives, opioids and hypnotics. Abnormalities of the cardiovascular system are also common in Down syndrome. Case Report: A nine_ day old male preterm newborn with DS (e.g. gestational age of 35 weeks) was brought to operation room (OR) for insertion of central venous line and surgery of duodenal atresia. During transportation to NICU, in OR he arrested and then after 45 minutes resuscitation, he returned to life. Conclusion: The placement of CVL could precipitate triggers of cardiac arrest, particularly in preterm newborn. INTRODUCTION Down syndrome(DS) is one of most prevalent congenital abnormalities(1).It is most obviously that outcome is poor in resuscitation cases due to cardiac or cardiorespiratory arrest, and is associated with 87% to 89% mortality rate or sev- er morbidity(2). Children with heart disease in comparison with patients without heart disease may be sicker in the time of occurrence of anesthesia – related cardiac events and they experience higher mortality rate. These types of arrests are frequently reported from general operation room and it has probably originated from cardiovascular reasons (3). In one study, mortality was particularly as high as 56% in duodenal stenosis DS patients. Associated congenital heart disease es- pecially endocardia cushion defects and high prevalence of pneumonia are contributor factors in this remarkable mor- tality rate(4).Obstruction of upper airway in children with Down syndrome is frequently a complex course with vari- ous causes and symptoms of residual airway obstruction are common in postoperative period(5). Although, due to medi- cal improvements in multidisciplinary cares, the median sur- vival rate of patients with DS has evolved (1). Unfortunately, Published by Australian International Academic Centre PTY.LTD. Copyright (c) the author(s). This is an open access article under CC BY license (https://creativecommons.org/licenses/by/4.0/) http://dx.doi.org/10.7575/aiac.abcmed.v.9n.2p.34 there is no comprehensive reports about incidence of all im- portant unpleasant events such as bradycardia during induc- tion of anesthesia, obstruction of natural airway and croup in post-intubation or-instrumentation period, even in children with DS (no cardiac case), it seems to be high in comparison with remain of children (2, 6). Case Presentation We present a nine- day old the preterm and premature male. DS with gestational age of 35 weeks, who was brought to operation room for insertion of central venous line and sur- gery due to duodenal atresia. His weight was 2400 grams. He was icteric, and has symptoms of atrial septum defect (ASD) in echocardiography. The surgery was performed within an hour without any problem and the vital signs were stable during operation 55 minutes after fnishing the sur- gery while was waiting for NICU staf in to transportation .During transferring the neonate to NICU, suddenly some changes appeared in electrocardiogram (ECG) such as tall T waves and bradycardia (HR=87 beat/min) and then Advances in Bioscience and Clinical Medicine ISSN: 2203-1413 www.abcmed.aiac.org.au ARTICLE INFO Article history Received: January 10, 2020 Accepted: March 02, 2021 Published: April 30, 2021 Volume: 9 Issue: 2 Conficts of interest: None Funding: We had not any sources of funding. Key words: Neonate, Resuscitation, Congenital Anomaly, Down Syndrome