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Multi-organ system failure in the neonate with group B streptococcal septicemia |
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| Organ system |
Abnormal findings |
Management |
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| 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 |
Hon et al. Italian Journal of Pediatrics 2009 35:10 doi:10.1186/1824-7288-35-10 |
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