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Spot diagnosis: An ominous rash in a newborn.

Hon KL, So KW, Wong W, Cheung KL - Ital J Pediatr (2009)

Bottom Line: Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics.PF associated with GBS is a rare cutaneous sign that must not be missed.Mortality remains high despite aggressive treatment and ICU support.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. ehon@hotmail.com.

ABSTRACT
Purpura fulminans (PF) is an ominous cutaneous condition usually associated with meningococcemia. PF in the newborn is rarely reported. We report the case of a female preterm infant with extensive PF due to group B streptococcus (GBS) septicemia. She developed multi-organ system failure despite neonatal intensive care support and succumbed 9 days later. GBS, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics. PF associated with GBS is a rare cutaneous sign that must not be missed. Mortality remains high despite aggressive treatment and ICU support.

No MeSH data available.


Related in: MedlinePlus

Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation.
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Figure 1: Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation.

Mentions: Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation 1. There was no family history of bleeding disorder. The membranes were ruptured 3 hours prior to delivery. The mother developed intrapartum fever (38.9°C) with chills and rigors and was given intravenous ampicillin and gentamicin 23 minutes before delivery by emergency caesarean section. At birth, the baby was apneic with heart rate of 80/minute. She cried and the heart rate responded upon bag and mask ventilation for 1 minute. Apgars were 8 and 10 at 1 and 5 minutes, respectively. On arrival at the NICU, the baby developed further apneas with cyanosis followed by tachypnea, insucking chest and grunting. Her mean arterial blood pressure was 30 mmHg and heart rate 190/minute. Arterial blood gas analysis showed a pH of 7.19, pCO2 8.03 kPa, pO2 2.25 kPa, and base excess of -6.9 mmol/L. Respiratory support (nasal continuous positive airway pressure of 5 cm H2O with 8 L/min of oxygen), normal saline bolus, and intravenous penicillin plus gentamicin were administered within the first hour of resuscitation. In the next 2 hours, she remained hypotensive despite further saline boluses, dopamine infusion and mechanical ventilation. Group B streptococcus, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. She was aggressively treated with broad antibiotic coverage, cardiopulmonary support with mechanical ventilation and multiple inotropes, and peritoneal dialysis (Table 1). The purpuric rash became more extensive and she developed progressive multi-organ system failure despite full intensive care support and succumbed 9 days later


Spot diagnosis: An ominous rash in a newborn.

Hon KL, So KW, Wong W, Cheung KL - Ital J Pediatr (2009)

Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698843&req=5

Figure 1: Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation.
Mentions: Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation 1. There was no family history of bleeding disorder. The membranes were ruptured 3 hours prior to delivery. The mother developed intrapartum fever (38.9°C) with chills and rigors and was given intravenous ampicillin and gentamicin 23 minutes before delivery by emergency caesarean section. At birth, the baby was apneic with heart rate of 80/minute. She cried and the heart rate responded upon bag and mask ventilation for 1 minute. Apgars were 8 and 10 at 1 and 5 minutes, respectively. On arrival at the NICU, the baby developed further apneas with cyanosis followed by tachypnea, insucking chest and grunting. Her mean arterial blood pressure was 30 mmHg and heart rate 190/minute. Arterial blood gas analysis showed a pH of 7.19, pCO2 8.03 kPa, pO2 2.25 kPa, and base excess of -6.9 mmol/L. Respiratory support (nasal continuous positive airway pressure of 5 cm H2O with 8 L/min of oxygen), normal saline bolus, and intravenous penicillin plus gentamicin were administered within the first hour of resuscitation. In the next 2 hours, she remained hypotensive despite further saline boluses, dopamine infusion and mechanical ventilation. Group B streptococcus, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. She was aggressively treated with broad antibiotic coverage, cardiopulmonary support with mechanical ventilation and multiple inotropes, and peritoneal dialysis (Table 1). The purpuric rash became more extensive and she developed progressive multi-organ system failure despite full intensive care support and succumbed 9 days later

Bottom Line: Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics.PF associated with GBS is a rare cutaneous sign that must not be missed.Mortality remains high despite aggressive treatment and ICU support.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. ehon@hotmail.com.

ABSTRACT
Purpura fulminans (PF) is an ominous cutaneous condition usually associated with meningococcemia. PF in the newborn is rarely reported. We report the case of a female preterm infant with extensive PF due to group B streptococcus (GBS) septicemia. She developed multi-organ system failure despite neonatal intensive care support and succumbed 9 days later. GBS, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics. PF associated with GBS is a rare cutaneous sign that must not be missed. Mortality remains high despite aggressive treatment and ICU support.

No MeSH data available.


Related in: MedlinePlus