Abstract
Background: Streptococcus pneumoniae is a rare cause of neonatal sepsis although associated with high morbidity and mortality. Objective: To report a case of early-onset preterm neonatal pneumococcal sepsis due to a penicillin-susceptible pneumococcus. Patients: An extremely low birth weight infant (gestational age 26 wks), presented shortly after spontaneous vaginal delivery with a sepsis due to Streptococcus pneumoniae and with respiratory distress? At 4 hours of age, the C-reactive protein (CRP) level was 60 mg/L, white blood cell (WBC) count was 35,000/mm(3), the immature/total neutrophil ratio (I/T) was 0.15, and the platelet count was 190,000/mm(3). Blood culture yielded Gram-positive cocci in pairs that were identified as Streptococcus pneumonae. Interventions: Antibiotics were switched from ampicillin and gentamicin to vancomycin and cefotaxime considering the possibility of resistance to penicillin. However, the organism was susceptible to penicillin, so the antibiotic therapies stepped down to cefotaxime monotherapy only. Infant was continued on cefotaxime for 14 days. Results: Infant was discharged home at 41 weeks corrected gestational age, on full oral-feeding and not on any respiratory support. Neurodevelopmental assessment at 18 months corrected age for her prematurity was appropriate for her age. Conclusion: This is a rare case of invasive pneumococcal disease in our institute. The following risk factors were involved in the occurrence of this case: preterm birth, very low birth weight, premature onset of labour and prolonged rupture of membranes (more than 18 hours). Cefotaxime monotherapy in a later part of the treatment phase was effective.