Index of Suspicion in the Nursery

Case Presentation

A 29-5/7-weeks’-gestation female is delivered by urgent cesarean delivery and develops respiratory difficulty soon after delivery. The mother is a 28-year-old primigravida who presented to the emergency department with high fever (102°F), chills, and a sore throat. Results of a rapid influenza antigen detection test (BinaxNOW^® Influenza A & B, Alere Inc, Waltham, MA) on nasopharyngeal swab were positive for influenza A and negative for influenza B. Test results for respiratory syncytial virus and legionella were negative. Her clinical course was complicated by mutlilobar pneumonia and adult respiratory distress syndrome requiring intubation and mechanical ventilation. Results of repeat rapid influenza antigen tests were negative at 36 hours after starting oseltamivir.

The mother received one course of betamethasone 48 hours before the cesarean delivery (with membranes intact), which was performed because of worsening maternal condition. The infant weighed 1,500 g at birth and had Apgar scores of 9 at both 1 minute and 5 minutes. Because of respiratory distress, the infant underwent resuscitation (Neopuff™, Fisher & Paykel Healthcare Limited, Panmure, Auckland, Australia) and was transferred to the NICU. She received one dose of surfactant and was immediately extubated to nasal continuous positive airway pressure. The infant’s initial chest radiograph showed mild haziness and a possible right upper lobe infiltrate consistent with pneumonia. …