Case 15 History ---- The patient was the 1200g female product of a 34 week gestation to a 20 year old G4P1Ab2 female. Pregnancy was complicated by an ectopic twin gestation removed by laparotomy at 10 weeks, pregnancy-induced hypertension, tobacco use, sexual assault, and intrauterine growth retardation. Her mother was induced for delivery which was without complications. Apgars were 9 at one minute and 9 at five minutes. Initial exam of the baby was only notable for small size. The baby did well for approximately 36 hours but at that time spiked a temperature to about 38°C. Increased respiratory distress was noted. Full septic work-up was done including an LP which was grossly bloody. Gram stain revealed sheets of gram positive cocci. Ampicillin and gentamicin were begun and the baby was noted to have generalized tonic-clonic seizure activity. The organism involved was group B streptococci. Phenobarbital was started. Increased respiratory distress was noted, the baby was intubated and transferred to SLCH for further care. Despite aggressive care of sepsis, meningitis and respiratory distress including treatment with antibiotics, intravenous gamma globulin, steroids, and respiratory support the baby eventually developed overwhelming sepsis with systemic hypotension, DIC, neutropenia and continued seizures and eventually expired at 3 days of age.
