The baby was seen by a primary care physician two 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.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
