Note: White blood cell count (per dm3); Neutrophil
percentage N%); CRP, C-reactive protein (mg/ liter); Temperature (℃);
White blood cell count (per dm3); Hb (g/liter); AST,
Aspartate aminotransferase, (U/liter); CK-MB, Creatine kinase isoenzyme,
(U/liter) ;*APTT, activated partial thromboplastin time(sec); Glu
(mmol/liter); Lac (mmol/liter); BE (mmol/liter); bowel
sounds(beats/min).
Forty-eight hours after birth, the infant’s skin was pale yellow and
systemic edema was unchanged. Bowel sounds were weak. Mucus stools and a
liquid dark area on abdominal ultrasound were observed (Table 1).
Neonatal necrotizing enterocolitis was suspected, and we presume that it
was caused by circulatory disturbances and secondary organ damage due to
a severe congenital infection. To avoid serious multi-organ infection,
circulatory failure, shock, and even death, a decision was made to
administer imipenem/cilastatin as antimicrobial therapy.
Bacterial culture was still underway preliminary findings were
suggestive of Listeria infection. Therefore, 62 hours after
birth, the infant was given imipenem/cilastatin combined with
intravenous amoxicillin sulbactam as antimicrobial therapy. Additional
treatments administered included dopamine to improve circulation, an
erythrocyte suspension to correct anemia, and parenteral nutrition.
However, 70 hours after birth, the infant’s condition deteriorated and
she gradually developed shortness of breath accompanied by a triple
concave sign. The aspiration sounds of both lungs were symmetrical and
scattered wet rales could be heard. Thirty minutes later, her anterior
fontanel became slightly dilated and she developed meningitis symptoms
including gazing, twitching of limbs, and clenching both fists. The
infant was given intramuscular injections of phenobarbital for sedation
and furosemide to reduce intracranial pressure. Her heart rate dropped
to 60 beats/minute. Blood gas analysis showed a pH < 6.8. The
infant died 72 hours after admission to the hospital. On the second day
after her death, the results of blood culture and drug sensitivity tests
confirmed L. monocytogenes infection.
In the mother, antimicrobial therapy was switched to piperacillin and
sulbactam. After 40 hours, the mother’s temperature and blood cell
counts returned to normal (Table 1).