Changing the Culture Around Cultures

[摘要] A 5-day-old female infant presented to a children’s hospital emergency department (ED) with jaundice. She was born at 38 weeks’, 4 days’ gestation with a weight of 3400 g after an unremarkable pregnancy and perinatal course. By parental report, a 36-hour bilirubin level was 9 mg/dL, and she did not receive phototherapy. Her mother’s blood type was B, Rh positive. The baby was exclusively breastfed, nursing every 2 to 4 hours for 20 minutes per breast. Voiding and stooling patterns were appropriate. In the ED, she was afebrile and well appearing with a weight of 3380 g. At 130 hours after birth, her total serum bilirubin (TSB) was 19.4 mg/dL. The ED provider decided to admit the patient for intensive phototherapy. During her observation in the ED, the infant had acute decreases in oxyhemoglobin saturation by pulse oximetry (SpO2) to 90% while asleep, self-resolving within seconds. Therefore, the ED provider initiated a partial sepsis evaluation including blood culture, complete blood count with differential, and C-reactive protein. The complete blood count and C-reactive protein were normal. While an inpatient, she received phototherapy for 6 hours and was discharged from the hospital after an appropriate postphototherapy TSB.At 27 hours of incubation on continuous monitoring, Gram-positive cocci in clusters were detected from the blood culture. The discharging inpatient team referred her back to the ED for further evaluation. The patient had remained afebrile without changes in her activity, breastfeeding, or urine output. An interval weight was appropriate. In the ED, sepsis was presumed given “young age and early growth [of the blood culture].” Therefore, a full evaluation for neonatal sepsis including lumbar puncture was performed. The evaluation was completely reassuring without signs suggestive of infection. She received empirical ampicillin and cefotaxime. Just before inpatient admission, the Verigene BC-GP assay …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob