Noma Neonatorum Caused by Acinetobacter Sepsis in a Premature Baby

Abstract

We admitted a female twin delivered at 31weeks’ gestation in another hospital referred to our hospital. Apgar scores were 6-7-7 at 1-5-10mins, and the weight was 1260g. On examination, baby have mild respiratory distress, cardiac auscultation was normal, neonatal reflexes mildly depressed. Other systemic examinations were remarkable. The baby was stabilized with continuous positive airway pressure (CPAP) with PEEP 6 and was transferred to the neonatal intensive care unit (NICU). Compled blood cell (CBC), biochemistry analysis, C-reactive protein (CRP), procalsitonin, blood culture was taken, and the baby was treated empirically with ampicillin and gentamicin. Cranial ultrasound revealed grade 2 intraventricular hemorrhage. On day 6 she developed increasing respiratory distress and hypotension. A sepsis evaluation was performed including blood cultures, and a CBC had a hemoglobin of 16.1g/dl, platelets of 43,000mm3 and a white blood cell count of 33.860/l with 74.3% segmented neutrophils, 15.5% lymphocytes, 5.9% monocytes, 3.9% eosinophils. CRP elevated 205mg/L (normal range <5mg/L), and procalcitonin levels was 36.8ng/ml (normal range <0.05ng/ml). Treatment changed with vancomycin, meropenem, colisitine and liposomal amphotericin B. Pentoxifyline added her treatment. On day 8 a pustular rash appeared in the anal regions and the general condition of the patient has deteriorated. In addition, she developed severe hypotension necessitating pressor support with dopamine, dobutamine, epinephrine and norepinephrine. Blood culture result of multi drug resistant A. baumannii and antibiotic sensitivity test was performed which showed A. baumannii sensitive to only ciprofloxacin, tetracycline and colisitine. Based on the culture and sensitivity test ciprofloxacin added the treatment. Supportive treatments were added fresh frozen plasma, thrombocytes and erythrocytes product packets. Swabs were taken from the pharynx, the rectum, and both eyes and were found as a negative. On day 9 the perianal and genital region was also erythematous and edematous around the necrotic center (Figure 1).