Baby Boy Case

Baby boy A., preterm, 36 weeks by Ballards score was delivered by Ceasarian section at a private hospital to a 32 year old multigravid with Apgar score 8 and 9 at one and five minutes, respectively. Birth weight was 2.3kg. Birth length 45 cm.

Mother, on the 3rd trimester, had urinary tract infection treated with Amoxycillin 500mg/cap, 1 capsule TID for 1 week. Thereafter she was admitted in a private hospital due to preterm labor where tocolysis was done. Two days prior to delivery, the mother had persistent watery vaginal discharge. She was admitted at a private hospital. Pelvic ultrasound done showed Pregnancy uterine 36 weeks.

Upon delivery, the patient had good cry and activity. On physical examination, patient had features compatible
If positive, a repeat test is done after 24-36 hours of antibiotic therapy. If still positive, modification of drug treatment may be necessary. CSF findings are elevated WBCs (predominantly PMNs), elevated protein, dec glucose and positive culture results). Note that CSF WBC can be within range in 29% of GBS (group B strep) meningitis but 4% in gram-negative meningitis, and protein and glucose levels can also be within range in 50% and 15-20% respectively as well.
- imaging- CXR may show lobar or segmental infiltration but will more often show diffuse patterns as seen in respiratory distress syndrome. CT or MRI may be needed late in the course of a complex neonatal meningitis to document hydrocephalus, abscesses, or signs of chromic disease (ventricular dilation, atrophy, etc). Head ultrasound may be used to document ventriculitis, ECF, or other chronic chnages. Generally imaging does not help much in the initial onset of neonatal sepsis

8. Formulate and discuss the best principles of therapeutic management (including preventive measures) for this
(if high index of suspicion = clinical judgement!)

Supportive Management

* For significant anemia, thrombocytopenia, or coagulation problems: Transfuse blood products (packed red blood cells, platelets, fresh frozen plasma) * Maintain thermoregulation (IF with temperature instability) * Adequate glucose control * Support vital signs - constant monitoring * Cardiopulmonary support and IV nutrition (in this case, does not seem warranted since there were no signs of poor feeding) may be required during acute phase until the patient stabilizes

*The trans discussed how to treat complications and adjunctive therapies (which, FYI, haven’t been supported by any substantial clinical trials. wala lang), but they don’t seem to be applicable here.

Neonatal