Case 8 History ---- The baby was a 35 week gestational age, 1790 gm female who was the product of an uncomplicated pregnancy. At 11 hours of age the baby became stiff, cyanotic and bradycardic with a heart rate of 100. The patient had several similar episodes and was then transferred to SLCH at 20 hours of life. Her eyes had scleral icterus. On neurologic exam, the patient was hypertonic with spontaneous extension of all extremities to minimal stimulation with decerebrate posturing. Hyperreflexia of the lower extremities was noted. Chest X-ray showed hazy infiltrates of the right and left lung fields consistent with hyaline membrane disease. Laboratory studies at that time revealed a bilirubin of 8.2, Hct. of 50, Ca of 9.6, glucose of 76 and normal electrolytes. Capillary blood gases showed an oxygen of 51, a CO2 of 40 on 100% O2 by endotracheal tube. Lumbar puncture showed 5,000 cells without acid, 400 cells with acid, 80% polys, 20% monos with numerous gram positive cocci. The impression was that the baby had sepsis due to probable group B Beta Hemolytic Streptococcus and was therefore started on Ampicillin 200 mg/kg, Kanamycin 15 mg/kg, and fluid restriction. For continuing seizures, the patient was also given 30 mg/kg of Phenobarbital and 20 mg/kg of Dilantin. Over the next 18 hours the baby continued to have frequent seizures despite further doses of Dilantin. The baby also had heart rate decelerations, irregular respiration, and several cardiopulmonary arrests. GI bleeding also developed and the baby became progressively unresponsive and expired.
