This case involves a male newborn delivered via C-section. The mom had been seen in the emergency room for fever with a temperature of 103. After the baby was born, labs and cultures were drawn due to the suspicion of chorioamnionitis. A placental sample tested negative for chorioamnionitis. The baby was in the newborn nursery for several days until discharge. The baby was seen by a primary care physician 2 days after discharge and there were no concerns during that visit. One week later, the baby was rushed to a local emergency room after becoming profoundly lethargic, blue in the skin, and hypothermic. The baby also had a dramatic drop in urinary output and had a reported body temperature of 90 degrees. Aggressive resuscitation efforts were started to get her stabilized for transfer to a PICU at another facility with IVF via IO’s. Antibiotics were not administered nor were labs and cultures drawn prior to transfer. The baby died several days later due to sepsis. A blood culture that had been drawn came back positive for coagulase-negative staphylococci.
Question(s) For Expert Witness
- 1. How often do you treat newborn patients with coagulase-negative staphylococci infections?
- 2. What are the most common risk factors for developing CoNS sepsis in a newborn?
Expert Witness Response E-042480
I regularly treat newborns with CoNS infections, predominantly in the NICU in the preemie population where it is considered a true pathogen. I have to say, in this patient, CoNS is extremely unlikely to be a pathogen and if it were to be, it is a normal skin colonizer so to say it came from the mother due to any breach in the standard of care would be highly unlikely. Due to the severity of illness of the infant, without knowing the mother’s history, I would be highly concerned for disseminated HSV infection and if that was not suspected and tested for then that is a problem. As above, CoNS sepsis evolves primarily in neonates in the NICU who are premature or have indwelling central venous lines that can act as a source. It tends to cause illness but on the whole, is relatively avirulent and does not typically cause fulminant sepsis, like this case. I have never seen an infant die from CoNS even in that population that is most at risk for it. I have reviewed a number of cases of neonatal sepsis and death.