Index of Suspicion in the NurseryCase: Swelling Over the Scalp at 8 Days of Age

Case Presentation

A term appropriate-for-gestational age male infant who was born by vacuum-assisted vaginal delivery to a 31-year-old G1P0 woman presents to the emergency department at 8 days of age after his mother noted a swelling on his scalp. The mother's prenatal laboratory results, including group B Streptococcus status, were negative. Delivery was complicated by prolonged rupture of membranes greater than 24 hours and development of preeclampsia. The neonate had an uneventful nursery course and was discharged after 72 hours.

At 6 days after birth, the mother noted swelling of the scalp in the occipital area that spontaneously resolved, but another similar lesion developed in the right parietal region, progressively increasing in size. The mother reports normal urine output and bowel movements and denies any fever, irritability, lethargy, decreased oral intake, or feeding difficulties. She states that the child has been exclusively breastfeeding since birth. On physical examination, the infant is afebrile, vital signs are stable, and the only pertinent finding is a 1.5×1.5-cm edematous and erythematous lesion over the right parieto-occipital area that is oozing yellowish material and a 0.5-cm lesion at the level of the lambdoid suture that has a crusted scab. The baby is admitted to the inpatient unit for further management with parenteral antibiotics and to rule out sepsis.

On admission to the inpatient unit, the complete blood count is within normal limits, and blood, cerebrospinal fluid (CSF), and scalp wound cultures are sent. A complete review of the maternal obstetrics …