Neonatal stridor and Staphylococcus aureus: Are they related?

Abstract

Staphylococcus aureus septicemia in the neonate can be complicated by the development of pneumatoceles. Affected infants usually present systemically unwell with raised inflammatory markers and worsening respiratory failure. We report the clinical progress of an extremely premature infant born at 25 weeks' gestation diagnosed with invasive S. aureus septicemia, previously stable on noninvasive respiratory support, who developed acute onset stridor on day 14 of antibiotic treatment. Further evaluation demonstrated a large pneumatocele in the right lower lobe with associated deviation of the major airways. Distortion of his trachea and right main bronchus by the pneumatocele was felt to be the most likely explanation for the acute onset of stridor. Intubation and ventilation was required for respiratory support at this stage. Of note, while there had been an acute inflammatory marker rise at the onset of the septic episode, by the development of acute stridor this had normalized, and clinically there were no acute respiratory concerns for this infant. To the best of our knowledge, this is the first reported case of a pneumatocele presenting with stridor. This case highlights the need for vigilance in extremely preterm infants with S. aureus septicemia and an awareness that pulmonary complications may arise during the recovery phase of such septic episodes.