Sudden Onset of a Unilateral Erythematous Preauricular Mass in a Preterm Infant

Prenatal and Birth Histories

• Born to a 26-year-old gravida 3, para 1 woman

• Prenatal course significant for benign screening results, preterm labor, premature prolonged rupture of membranes (∼26 hours), and placental abruption with incomplete antenatal corticosteroid administration; no maternal fever, maternal administration of latency antibiotics

• Estimated gestational age: 24 5/7 weeks

• Spontaneous vaginal delivery with bloody amniotic fluid

• Prenatal maternal laboratory findings: Group B Streptococcus (GBS) status unknown, gonorrhea/chlamydia negative, Trichomonas negative, quantiferon gold negative, human immunodeficiency virus negative, rapid plasma reagin nonreactive, hepatitis B negative, varicella zoster virus immune, rubella immune

• Received adequate intrapartum antibiotic prophylaxis for GBS (7 doses of ampicillin)

• Apgar score: 8 at 1 minute and 9 at 5 minutes

• Birthweight: 700 g (46th percentile), length: 33 cm (70th percentile), head circumference 21 cm (11th percentile)

• Resuscitation: Infant required positive pressure ventilation followed by intubation for apnea

Initial Hospital Course

The infant was given endotracheal surfactant and placed on high-frequency jet ventilation. Blood and respiratory culture specimens were obtained and empiric antibiotics initiated. Respiratory culture was positive for Eikenella corrodens and placental pathology demonstrated necrotizing funisitis and chorioamnionitis. Antibiotics were switched to cefepime after sensitivities became available. At 8 days of age, she had an acute cardiopulmonary arrest in the setting of cardiac tamponade because of a hemorrhagic pericardial effusion. A pericardial pigtail catheter was placed and removed on day 12 with echocardiography demonstrating resolution of the effusion. Echocardiography also revealed a small ventricular septal defect and large patent ductus arteriosus, which was treated with 2 courses of indomethacin followed by acetaminophen. Respiratory support was weaned and the infant underwent extubation to continuous positive airway pressure on day 34. Central lines were removed on day 16 following advancement of enteral fortified breast milk feedings. Cranial ultrasonography …