I am not sure what you are treating. And I would not generally consider sending
home an infant on po meds. If you are concerned about GBS, you need to treat IV
10-14 d. If not, stop the bug juice. I don't think there is a read difference
between 189K and 230K platelets especially if obtained via heel stick. Normally
I'd try to get another blood culture if there has been more than 12 hrs since the
last one and some change that suggests the start of abx would be appropriate. The
infant could have had a viral infection - who knows. But now you are stuck. If
you can have good followup and the baby seems quite stable, I'd vote for a d/c abx
and close follow-up with repeat blood cul 3 days off abx if still worried.
-gb
----- Original Message -----
From: "Herb Ruhs" <>
To: <>
Sent: Saturday, October 27, 2001 8:22 PM
Subject: I have a puzzling newborn
Hi folks,
I have a six day old that has me puzzled. I revewed this with the local
neonatologist and he can't think of what else to do either. Maybe
you'all have a suggestion or two.
This was a term newborn male product of inadequate and discontinuous
prenatal care to a Beta strep positive mom who only got one dose of
amp. Day one seemed fine though the nurses think he looks a bit strange
in the face. Day two covering doc does a cbc and blood culture to
reassure herself about the partially treated beta strep. Day three
there are breast feeding problems, decreasing urine out put and the cbc
shows about 10.0 wbc, equally divided between neutros and lymphs. There
are a few too many monos and eos but only one or two bands at most. The
feeding problem responded well to Lactaid breast feeding assist and
coaching and babys hydration improved. Jaundice was present on day 2
and a T Bili was 9ish with about 10% direct. Repeats stayed stable and
dropped abruptly with hydration but direct stayed about 10%. Blood and
urine cultures have been negitive so far. An ititial cath specimen
produced only about 1cc of thick yellow stuff. Gram stain and micro
showed urate crystals with no organisms. A bactogen on urine was neg.
The puzzle is that serial cbc's have shown a drift down of wbc's to
yesterday's cbc that shows wbc 6.4, hgb 18.7, mcv 102, plts 189
(trending down from an itiat 230 at day 2), neutros 34, lymphs 40,
Mono's 15, and eos 9, no bands. Based on poor feeding and low wbc's
child was started 2d ago on Amp and Claforan IV and seems to be doing
well. Current idea is that if continues to do well will dc antibiotics
and dc home to complete an oral course of amox after 72 hours if
cultures remain negitive and he stays stable off IV antibiotics for
about 12 hours. What happens if white count continues to drop,
platelets drift down, etc. in an other wise healthy baby with negitive
blood, urine cultures and neg bactogen?
Continue to follow cbc's? Find a hematologist?
Trapped in the boonies without an oar.
herb
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