Index of Suspicion in the Nursery

Abstract

A 10-day old male infant in the neonatal intensive care unit (NICU) has a small amount of purulent drainage from his right eye, but no other signs of infection. His respiratory rate is 40 to 64 breaths/min, with oxygen saturations of more than 90% in room air and no significant episodes of apnea. His pulse is 140 to 164 beats/min, with no significant episodes of bradycardia, and his temperatures are recorded at 97.7° to 98.1°F (36.5° to 36.7°C) in a heated bed. He is tolerating feedings of expressed human milk through a feeding tube and has gained weight consistently since the sixth postnatal day, although he is still approximately 100 g below birthweight. His only medication is caffeine for apnea of prematurity, which was started on the second postnatal day. The patient was born at 29 4/7 weeks’ gestation to a 35-year-old, G2P1→2 woman who developed preterm labor that was resistant to tocolysis with magnesium and nifedipine. The infant was delivered vaginally and resuscitated in the delivery room with supplemental oxygen via facemask. Apgar scores were 7 at 1 minute and 8 at 5 minutes. His birthweight was 1,660 g. He was admitted to the NICU because of preterm birth and mild respiratory distress syndrome. Laboratory tests upon admission included a complete blood count (CBC) and blood cultures, and ampicillin and gentamicin administration was initiated. His initial CBC revealed a white blood cell count of 14.3×103/mcL (14.3×109/L), with 58% neutrophils, 3% bands, 25% monocytes, and 14% lymphocytes. He received a total of four doses of ampicillin and two doses of gentamicin over the first two postnatal days; antibiotics were discontinued when initial blood cultures showed no growth at 48 hours. He did not require intubation; he was maintained initially on continuous positive airway pressure and then …