Early Onset Neonatal Sepsis and Meningitis

Brief History of the Present Illness A 6-day-old female with septic shock was admitted to the hospital in the fall. Two days before admission, she had developed a macular rash on her face and extremities that was attributed to a normal newborn rash. She also had difficulty with breastfeeding, and her mother started formula supplementation upon suggestion by her pediatrician. Over the next 48 hours, the baby became lethargic and the rash became generalized. The patient returned to the pediatrician’s office, and the physician noted that she was listless, her oxygen saturation was 48% in room air, and she had a heart rate of 72 beats per minute. An arterial blood gas analysis showed a pH of 7.08 and a pCO2 of 96 with a base deficit of −1. The patient was apneic with occasional periodic breathing and seizure-like activity. She was intubated, volume-resuscitated with 8 mL/kg normal saline as well a continuous infusion of D10W at 4 mL/kg per hour. She was given ampicillin, gentamicin, and phenobarbital. She was then transferred to the Pediatric Intensive Care Unit.