Newborn Female with Hypoxic Respiratory Failure and Persistent Pulmonary Hypertension: A Case Report

Abstract

Streptococcus pneumoniae (SP) is a rare but well recognized cause of sepsis in neonates.Persistent pulmonary hypertension of newborn (PPHN) is one of the serious complications of SP and afrequent cause for morbidity and mortality in neonatal SP sepsis. It is a state of oxygenation failurecharacterized by high pulmonary vascular resistance with right-to-left shunting of venous blood. Inhaled NO(iNO) and extracorporeal membrane oxygenation (ECMO) have proven beneficial to infants who failed torespond to ventilation. Here we report a case of SP sepsis. The patient was a term female, who presentedwith rapidly progressing respiratory failure that occurred hours after birth. She subsequently developedsevere PPHN, which did not respond adequately to ventilation and iNO. The patient was intermittentlymanually ventilated over a 3-hour period to keep SpO2 at 50-70%. She had leukopenia, bandemia,elevated inflammatory markers, and positive blood culture for SP. Ampicillin and meropenem wereadministered to treat fulminant sepsis. She was transferred to a Level IV NICU in urgent need of ECMO.After transport, she improved on conventional ventilator and iNO without ECMO, and was discharged homeon room air on day of life 39. The patient is currently a 12-month-old healthy female without anydevelopmental issues.