She is admitted to the Neonatal Intensive Care Unit from the delivery room, a preterm newborn of 36.6 weeks of gestational age, weighing 2.555 g, due to neonatal depression and infectious risk.APGAR type IV/7/9, requires
The mother presented, 24 h before delivery, a fever accompanied by abdominal pain.
Due to the clinical suspicion of chorioamnionitis, she received antibiotic treatment and underwent cesarean section under general anesthesia for non-progression.
Hemoculture was extracted from the newborn and treatment with broad-spectrum antibiotics was initiated.
After a good initial evolution, on the fifth day of admission there is a fever peak; new blood, urine and cerebrospinal fluid (CSF) cultures are extracted.
In the following 48 hours his general condition deteriorates, with metabolic acidosis, anemia, platelet count (minimum count 10,000/mcl) and lower gastrointestinal bleeding, so the antibiotic treatment is modified to cover a possible necrotizing enterocolitis.
In the following 24 h she developed coagulopathy (prothrombin activity 30% and non-coagulated cefalin time) and liver failure; she had generalised petechiae and major bleeding by umbilical venous catheterization points and peripheral blood 15 cm
In the hepatogram, maximum transaminase concentrations reached bilirubin 957 U/L, GPT 237 U/L and total GGT 144 U/L, FA 93 U/L, LDH 5031 U/dl.
Due to the clinical suspicion of viremia, and due to the possibility of herpetic infection, antiretroviral treatment is initiated.
Taking into account the possible etiologies of neonatal hepatitis (see Table 1), a microbiological study is performed to rule out EBV, CMV, herpes simplex types I and II, enterovirus, adenovirus, toxoplasma, rubella.
A study was also performed to rule out alpha-1-antitrypsin deficiency in the neonatal blood, urine reactive antibodies, and determination of glucose-1-phosphate-uridylotransferase enzyme activity, ferritin-tyrosine saturation.
The clinical picture was accompanied by a slight increase in muscle enzymes (CK 476 U/L, CK-MB 307 U/L and troponin T 0.95 ng/ml) with normal transfontanellar and abdominal echocardiographic findings.
On the eighth day of life, recovery of liver function parameters and normalization of coagulation began.
After knowing the result of PCR for enterovirus in the blood, antibiotics and virovirus are suspended.
Meningoencephalitis was ruled out by PCR in cerebrospinal fluid.
After 23 days of hospitalization she is discharged.
After one month, the patient is asymptomatic, with good gain, normal physical examination and normal levels of hemoglobin, platelets, ferritin, coagulation and hepatogram.
1.
The mother had a favorable evolution, with disappearance of fever within 48 h after delivery.
She received five days of antibiotic treatment until blood cultures were negative.
No family epidemic environment was reported.
