Is This Infant Septic?

Putting AAP Recommendations Into Practice

Praveen Kumar, MBBS, DCH, MD


December 03, 2012

An Apparently Healthy Newborn -- or Not?

Editor's Note:
In April 2012, the American Academy of Pediatrics Committee on Fetus and Newborn issued a clinical report on the management of early-onset neonatal sepsis. This article is based on recommendations from this important report.

A full-term female infant is born to a 24-year-old single, black, primigravida woman by an assisted forceps delivery, secondary to a prolonged second stage and maternal exhaustion. The mother had good prenatal care. Her body mass index is 30 kg/m2, and weight gain during pregnancy was within the normal range. She was noted to have mildly elevated blood pressure during late gestation.

Glucose tolerance testing was normal. The mother is rubella-immune, and prenatal screening for hepatitis B, HIV, group B streptococcus (GBS), and syphilis was negative. She received epidural anesthesia during labor, and the duration of ruptured membrane was approximately 24 hours. She required several vaginal examinations during labor because of slow progress.

The mother was noted to be febrile (100.8°F) late in the second stage, with no other signs of chorioamnionitis; she did not receive antibiotics. Her obstetrician attributed her low-grade fever to epidural anesthesia, long labor, and maternal exhaustion.

You were called to attend view of the assisted forceps delivery and maternal temperature. The infant was active and vigorous at birth and did not require any resuscitative measures. Her Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.

On physical examination, the infant appears well and is at the 50th percentile for height and weight. She is afebrile and has normal vital signs. The remainder of the physical examination is unremarkable, with no apparent congenital malformations. You concur with obstetric assessment that maternal fever is unlikely to be infectious in origin; therefore, the infant was allowed to stay with the mother and no additional work-up was done.

Four hours later, the nurses call you back because the infant is having difficulty maintaining a temperature in the normal range and has not fed well.