This is an uncontrolled pregnancy, with a 41 year old mother (G4A0V3), rubella and toxoplasma.
Rectovaginal smear not performed.
The estimated gestational age by biometry is 33-34 weeks.
She received a complete steroid cycle and required treatment for preeclampsia and acute pulmonary edema.
An urgent cesarean section was performed because of maternal causes, with a ruptured intraoperative bag and clear amniotic fluid.
Apgar score 7/9, REA III.
Weight of the newborn (NB) 1600 g.
He was not statured due to clinical instability.
She required transfer to a Neonatal Intensive Care Unit (NICU) type IIIC at 12 hours of life due to hyaline membrane disease, severe pulmonary hypertension and hemodynamic instability.
This center needs several cycles of antibiotic therapy for nosocomial sepsis and for suspected unconfirmed necrotizing enterocolitis, and receives a transfusion of concentrated proteins.
Follow-up was performed with serial brain ultrasound, with no significant findings.
Normal EEG.
At 26 days of life, with a corrected gestational age of 36+4 weeks, she is returned to our center.
At 38 days of life, there is an absence of spontaneous movement of the right arm, with a Mor asymmetric reflex and poor mobilization, with swelling and minimal erythema of the right shoulder, which is painful.
Articular ultrasound showed mild hyperechogenic joint effusion suggestive of complicated effusion.
Puncture and drainage were performed with non-incidence needle, obtaining 2 ml of hemopurulent fluid. Empirical treatment was initiated with cefoxime and intravenous cloxacillin.
After drainage the swelling is reduced although the size of the right shoulder persists in relation to the left.
After 48 hours, it was confirmed that E. coli grew without resistance in the antibiogram, so cloxacillin was suspended, keeping cefoxime monotherapy.
After five days of intravenous treatment, a new sample of C-reactive protein (CRP) is obtained, which is 14.6 mg/dl, despite not presenting clinical worsening of the shoulder.
Again, the ultrasound is repeated, showing a minimal joint effusion and an incipient tapered collection on the anterior face.
A new ultrasound-guided drainage was performed.
0.3 ml of the sample is obtained, in which the same multisensitive E. coli grows.
After seven days of treatment, it was decided to associate intravenous amikacin to potentiate the antibiotic effect by mild increase in CRP.
After this, at 72 hours there was a marked clinical and laboratory improvement.
Due to the good clinical and analytical evolution, it was decided to switch to cefuroxime-axlo to complete three weeks of oral antibiotic.
