This case involves a 12-day-old infant born a week premature in Florida. The infant was hospitalized for 5 days due to a hemolytic disease requiring phototherapy. Two days following discharge, the patient presented to the emergency department having multiple episodes of passing stool and vomiting. On admission, the newborn was diagnosed with profound metabolic acidosis and multi-system organ failure. He was transferred to NICU but was pronounced dead the following morning. The parents consented to an autopsy which revealed neonatal death associated with necrotizing bronchiolitis and multi-organ failure. The lungs showed necrotizing bronchiolitis and negative for the herpes simplex virus. The autopsy also revealed a backup of blood in the liver, resulting from heart failure, but no structural anomalies were found in his cardiovascular system. Given the combination of the infant’s presentation and autopsy findings, the main differential diagnosis included viral infection and inborn error of metabolism.
Question(s) For Expert Witness
1. Do you routinely treat patients similar to the one described in the case? Please explain.
2. Have you ever had a patient develop the outcome described in the case? If so, please explain.
Expert Witness Response E-027011
I am a Professor of Neonatal-Perinatal Medicine, Director of Research and Co-Director of a 50 bed Neonatal Intensive Care Unit. The most likely etiology is late onset bacterial sepsis leading to septic shock. Herpes can have a late onset similar to the scenario here although the cultures are apparently negative. An inborn error of metabolism could present with profound metabolic acidosis.
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