Sudden Onset of Neurologic Dysfunction in a Preterm Infant

Abstract

* Abbreviations: CBC, : complete blood cell CSF, : cerebrospinal fluid MRI, : magnetic resonance imaging PMA, : postmenstrual age SDE, : subdural empyema CT, : computed tomography WBC, : white blood cell One day after Nissen fundoplication and gastrostomy tube placement, a preterm female infant presents at 43 weeks’ postmenstrual age (PMA) with obtundation, unresponsiveness to painful stimuli, and bilaterally fixed, dilated pupils. ### Prenatal and Birth Histories ### Initial Clinical Course ### Presentation (Postoperative Day 4) Postoperative course was remarkable for hypertension secondary to suspected pain and need for increasing ventilator support. On postoperative day 4, a complete blood cell (CBC) count showed a white blood cell (WBC) count of 17,700/μL (17.7 × 109/L) with 35% bands. The hemoglobin and hematocrit were 15.8 g/dL (158 g/L) and 45.5%, respectively, with a platelet count of 238 × 103/μL (238 × 109/L). Although these laboratory findings raised a concern for an infection, the infant had unremarkable physical examination findings. Blood and urine culture were obtained (lumber puncture was deferred due to abdominal surgery) and the infant was started on broad-spectrum antibiotics (vancomycin, cefotaxime, and gentamicin). ### Progression (Postoperative Day 5) On postoperative day 5, an acute deterioration in the infant’s clinical status was noted. #### Vital Signs