Late-Onset Group B Streptococcus in the Late-Preterm Neonate
Late-Onset Group B Streptococcus in the Late-Preterm Neonate
At the time of her toxic presentation, the patient weighed 2.7 kg, which was appropriate for her corrected gestational age. She was extremely irritable and was not consoled by holding or gentle rocking. The infant had exaggerated responses to light, sound, and tactile stimuli. Despite reports of a prior low-resting heart rate, upon examination she had sustained tachycardia with intermittent episodes of intermittent bradycardia to as low as 70 beats per minute. Her blood pressure was appropriate for her corrected gestational age. She was pale and mottled, with delayed capillary refill in her distal extremities and weak brachial and femoral pulses. Her respiratory effort was labored as evidenced by nasal flaring and subcostal retractions, although her lung fields were clear to auscultation. She had increasing episodes of apnea lasting more than 20 seconds. Bowel sounds were auscultated over all four quadrants with no abdominal distention. Her upper and lower extremities were hypertonic. Lymphadenopathy was not present, and her temperature was within normal limits.
Pertinent Physical Examination Findings
At the time of her toxic presentation, the patient weighed 2.7 kg, which was appropriate for her corrected gestational age. She was extremely irritable and was not consoled by holding or gentle rocking. The infant had exaggerated responses to light, sound, and tactile stimuli. Despite reports of a prior low-resting heart rate, upon examination she had sustained tachycardia with intermittent episodes of intermittent bradycardia to as low as 70 beats per minute. Her blood pressure was appropriate for her corrected gestational age. She was pale and mottled, with delayed capillary refill in her distal extremities and weak brachial and femoral pulses. Her respiratory effort was labored as evidenced by nasal flaring and subcostal retractions, although her lung fields were clear to auscultation. She had increasing episodes of apnea lasting more than 20 seconds. Bowel sounds were auscultated over all four quadrants with no abdominal distention. Her upper and lower extremities were hypertonic. Lymphadenopathy was not present, and her temperature was within normal limits.
