XLIV Jornadas Nacionais de Neonatologia. Évora. 2015. Poster
Viral respiratory infections are predominant in children. Neonates are at higher risk of bacterial infection, thus empirical antibiotics are usually prescribed. An apparently robust neonate with severe bacterial respiratory infection is reported. Male neonate, born by caesarean section due to macrossomy (4650g), after an uneventful gestation. Admitted to the neonatal unit for early respiratory distress, he was discharged home after 5 days. At the 10th day of life, he presented with anorexia, respiratory distress, generalized cyanosis and oscillatory hypotonia. His older sibling had upper respiratory infection. At the ER, he had respiratory acidosis, 7,400 WBC/microL with no polymorphonuclear predominance, CRP 1.2mg/dL and hypotransparency of the right lung. Bacterial pneumonia was admitted and he was started on cefotaxime, ampicillin and gentamicin; due to the clinical instability, he was transferred to a neonatal intensive care unit, where assisted ventilation was started at admission. Congenital cardiopathy was excluded. For chewing movements and tonic extension of the upper limbs, he was on phenobarbital for 5 days; cranial ultrasonography and electroencephalography were normal. Haemophilus influenza was identified in the tracheal aspirate and cefotaxime was suspended. CRP was never positive. Tube feeding was well tolerated, he was extubated after 3 days and feeding by mouth was started. He was transferred to the hospital of origin at the 8th day, still dependent of oxygen supplementation. This report alerts to the potential severity of community acquired bacterial neonatal pneumonia and highlights the important role of both the paediatric emergency transfer system and the broad microbiological workout.