MedBugs: SAQ #639

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Case: Febrile neonate

A 12-day-old term neonate is brought to the Emergency Department with reduced feeding, irritability, and a rectal temperature of 38.4°C.

The parents report the baby has been sleepier than usual and had one episode of vomiting. There are no known perinatal risk factors, and the baby was previously well.

On arrival, the neonate is tachycardic (HR 185), tachypnoeic (RR 60), and appears mottled with delayed capillary refill of 4 seconds. Blood glucose is 3.2mmol/L. The anterior fontanelle is soft. No obvious source of infection is identified.

You are concerned about neonatal sepsis.

1. Excluding neonatal sepsis, list (5) important differential diagnoses to consider in this neonate 5 marks

2. List (3) empiric anti-microbial treatments (with dosing) you will provide in the resus bay. 3 marks

3. Provide (2) advantages and (2) disadvantages of performing an early lumbar puncture in suspected neonatal sepsis. 4 marks

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Case: Febrile neonate

1. Excluding neonatal sepsis, list (5) important differential diagnoses to consider in this neonate 5 marks

2. List (3) empiric anti-microbial treatments (with dosing) you will provide in the resus bay. 3 marks

3. Provide (2) advantages and (2) disadvantages of performing an early lumbar puncture in suspected neonatal sepsis. 4 marks

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