What do you think ?
Can we apply ?
A 5-day-old newborn male infant is transferred to your service for increased oxygen requirement and respiratory distress. He was born at 35 weeks of gestation to a 24-year-old lady, who is G7P6. She had seizure disorder for which she takes valproic acid and lamitrigine.
She had regular prenatal care and normal screening US. Delivery was complicated by PROM > 20 hr. Apgar was 9/9. Baby was nursed by mom in her room. On day 3 of life, mild tachypnea was noted and the physician on call performs the septic work up and started the baby on broad spectrum antibiotics. The following day, the baby was noted to be lethargic so LP was
done and IV cefotaxime was added. By early morning of day 5, the respiratory distress increased and baby needed intubation and then was transferred. On examination, you note the baby to be hypoactive with diminished reflexes. You order admission labs and repeat CXR. The nurse calls you as baby started to bleed from the nose. You noted oozing from the IV site. In the meantime, the lab calls you with panic report. CBC showed: WBC of 28 K, Plt 45K, PT 70, PTT 95, ALT 3567, AST 2458. The most likely diagnosis is
A. Fulminant GBS sepsis
B. Congenital Listerosis
C. Systemic HSV infection
D. Severe drug reaction
E. Parvo virus infection
Among the new recommendations
1 Mothers at high risk of preterm birth < 28–30 weeks’ gestation
should be transferred to perinatal centres with experience
in management of RDS (C1).
2 Clinicians should offer a single course of prenatal corticosteroids
to all women at risk of preterm delivery from when
pregnancy is considered potentially viable until 34 weeks’
gestation ideally at least 24 h before birth (A1).
3 A single repeat course of steroids may be given in threatened
preterm birth before 32 weeks’ gestation if the first course
was administered at least 1–2 weeks earlier (A2).
4 MgSO4 should be administered to women in imminent labour
before 32 weeks’ gestation (A2).
5 In women with symptoms of preterm labour, cervical length
and fibronectin measurements should be considered to prevent
unnecessary use of tocolytic drugs and/or antenatal steroids
6 Clinicians should consider short-term use of tocolytic drugs
in very preterm pregnancies to allow completion of a course
of corticosteroids and/or in utero transfer to a perinatal centre