Escherichia coli septicaemia arising as a result of an infected caput succedaneum

Excerpt

A baby girl, born at 36 weeks gestation by ventouse delivery with a weight of 2580 g, presented at 12 days of age because her parents had noticed a red swelling on her scalp. The baby had been induced because of pre-eclampsia and the ventouse had been done for failure to progress. She had been in good condition at birth and there had been no prolonged rupture of membranes or other risk factors for infection. She was afebrile and appeared generally well. There was a purplish discolouration of the left parieto-occipital area consistent with a caput succedaneum where the ventouse cap had been applied. In the centre of this was a red, fluctuant swelling which we diagnosed to be a scalp abscess. She was initially commenced on oral flucloxacillin, but 24 h later she was not waking for feeds and had become lethargic. A full blood count showed the following: WCC 27.8×10⁹, platelets 1,076×10⁹, haemoglobin 13.2 g/dl. The C-reactive protein was 87.2 mg/l (normal <5 mg/l). A skull radiograph showed a soft-tissue mass in the area but no bony involvement. Intravenous flucloxacillin and cefotaxime were commenced. The blood cultures grew E. coli sensitive to cefotaxime. The swelling burst after 4 days discharging blood and pus which was cultured and also grew E. coli. The baby improved clinically within a few days and received 7 days of intravenous flucloxacillin and cefotaxime and then 2 more days of intravenous ceftriaxone to which the organism was also fully sensitive. The discharging wound was dressed with magnesium sulphate and the advice from paediatric surgical colleagues was that no surgical treatment was necessary as the pus continued to discharge itself. Within 5 weeks the scalp had completely healed and there was no discolouration or break in the skin. A skull radiograph showed no bony changes and the baby has thrived and had no further problems. …