Table 1 Multi-organ system failure in the neonate with group B streptococcal septicemia
Organ system | Abnormal findings | Management |
|---|---|---|
Cardiovascular | Cardiogenic and distributive shock; poor perfusion; ejection fraction 54% and fractional shortening 26% . Highest creatine phosphokinase 1033 U/l and cardiac troponin 0.45 ug/l | Intravenous saline boluses, dopamine, dobutamine, epinephrine, hydrocortisone, milrinone, vasopressin |
Respiratory | Respiratory failure with hypercarbnia and diffuse haziness on chest radiograph | Mechanical ventilation, FiO2 1.0, surfactant, vecuronium |
Renal | Passed urine at 10 hours of life; persistent oliguria; anuria 4 days later. Highest creatinine 153 umol/l | Intravenous frusemide; peritoneal dialysis; gentamicin stopped |
Septicemic | Group B streptococcus, sensitive to penicillin, isolated on surface swabs, and in baby and mother's blood cultures; highest C-reactive protein 12.9 mg/l | Intravenous penicillin and gentamicin initially; ampicillin; cefotaxime; meropenim and vancomycin empirically; intravenous immunoglobulin Subsequently on high-dose penicillin and cefotaxime when group B streptococcus and sensitivity were available. |
Hematologic | Disseminated intravascular coagulopathy with lowest hemoglobin 8.6 g/dl, thrombocytopenia 13 × 109/l, D-dimer 9735 ng/ml, prothrombin time 60 seconds, and activated plasma thromboplastin time 120 seconds | Packed red cell, fresh frozen plasma, cryoprecipitate, platelet |
Metabolic | Metabolic acidosis (worst pH 6.87), hypoglycemia (glucose 1.0 mmol/l), hypocalcemia (0.63 mmol/l) | Dextrose and NaHCO3 infusion; calcium supplementation |
Neurologic | Convulsion | Anticonvulsant |
Hepatic | Deranged liver function with worst total bilirubin of 125 umol/l and alanine aminotransferase 574 IU/l | Supportive and treating underlying infection |