This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Case 1 Presentation
A baby boy is born by vaginal delivery after a 35-week gestation. During the week prior to delivery, his mother experienced low-grade fever, coryza, diarrhea, abdominal cramping, and mild vaginal bleeding. A small placental abruption was diagnosed, and labor was induced. In the first few hours after birth, the baby develops poor perfusion and tachypnea. Blood cultures are drawn, and he is treated with ampicillin and gentamicin for 5 days and improves. The cultures show no growth.
On the fifth day of life, just prior to discharge, the infant suddenly becomes apneic and again demonstrates poor perfusion. He is intubated, stabilized, and again evaluated for sepsis, including lumbar puncture. Antibiotics are changed to vancomycin and cefotaxime. Acyclovir is added.
His white blood cell (WBC) count is 14.1×103/mcL (14.1×109/L), with an absolute neutrophil count of 13.1×103/mcL (13.1×109/L) and bands noted on smear. Cerebrospinal fluid (CSF) results reveal 15×103/mcL (15×109/L) WBC, 3,920×103/mcL (3,920×109/L) erythrocytes (believed to be due to a traumatic puncture), a normal glucose level, and an elevated protein level. Bacterial cultures of CSF, blood, and urine are negative. Polymerase chain reaction (PCR) testing of CSF also is negative for herpes simplex.
For 24 hours the baby is stable, then quickly deteriorates. He rapidly develops hypotension, severe coagulopathy (with an international normalized ratio [INR] of 10 and partial thromboplastin time [PTT] of >150 sec), renal failure, liver failure, and acute respiratory distress syndrome.
Supportive care is initiated, including intravenous fluid, inotropic drugs, fresh frozen plasma, platelet transfusions, and eventually peritoneal dialysis. He develops a massive left intracerebral hemorrhage, resulting in brainstem herniation, with loss of brainstem reflexes. With parental approval, support is withdrawn on the eighth day after birth.
A test result reported after death …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.