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Table 1 Multi-organ system failure in the neonate with group B streptococcal septicemia

From: Spot diagnosis: An ominous rash in a newborn

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