JPED Journal

Abstract

Introduction: Neonatal sepsis can be defined as early and late onset. Early onset neonatal sepsis, within 24 hours after birth, has a prevalence of 85% of cases, 5% in the first 24-48 hours after birth and a small percent in the first 48-72 hours. Early onset sepsis is more common among preterm newborns. This type of sepsis is caused by acquiring pathogenic microorganisms from the mother, while late onset sepsis is cause by microorganisms from the environment. Newborns with congenital heart defects are twice as likely to develop sepsis, than other newborns. Material and method: In our study, we analyzed the case of a preterm newborn, with gestational age of 33 weeks, birth weight 2000 g, from a physiological pregnancy, born through C-section in cranial presentation, who after birth had generalized cyanosis, systolic murmur gr. II/VI audible over the entire cardiac area, without respiratory distress, and a satisfactory adaptation to the extrauterine environment. The echocardiography conducted after birth discovers a complex congenital heart defect (ASD, wide AVD, aortic arch hypoplasia. On day 32 of life the newborn develops respiratory distress, systolic murmur gr. IV/VI, positive inflammatory markers (leukocytosis, thrombocytopenia, positive PCR and procalcitonin), respiratory acidosis upon blood gas analysis and the decision to intubate and mechanical ventilation is made. After intubation the newborn develops pulmonary hypertension which led to an increase of ventilation parameters and the administration of Sildenafil and Dopamine. Despite, respiratory support the newborn deteriorates, developing pulmonary hemorrhage, numerous cardiorespiratory arrests, which finally led to death. Conclusion: We were faced with a preterm newborn with a complex congenital heart defect who developed complications at a later time after birth which led to an unfavorable evolution. The accuracy in diagnosing late onset sepsis is low due to signs and symptoms that are common to a great variety of causes for neonatal respiratory distress syndrome.

Keywords: Preterm; Sepsis; Congenital Heart Defect.