An infant was born at 36 weeks of gestation to a 30-year-old G3P2 mother via spontaneous vaginal delivery

4.1 An infant was born at 36 weeks of gestation to a 30-year-old G3P2 mother via
spontaneous vaginal delivery. Rupture of membranes occurred 15 hours prior
to delivery. Birth weight is 4000 g, and Apgar scores were 6 and 9 at 1 and 5
minutes, respectively. Which of the following factors places this infant at greatest risk for sepsis?
A. Maternal age
B. Gestational size
C. Apgar score
D. Length of time membranes were ruptured
E. Gestational age
4.2 A 25-day-old female infant is brought to the emergency department for fever
of 101°F (38.3°C) at home. The baby was born vaginally at full term and was
appropriate for gestational age. Maternal GBS was negative. Apgar scores were
8 and 9. The mother noticed the baby has had decreased feeding over the previous few days and has been sleeping more. Which of the following is the most
appropriate initial choice of antibiotics for this infant?
A. Oral amoxicillin
B. Vancomycin
C. Ampicillin
D. Ampicillin and cefotaxime
E. Ampicillin and gentamicin
4.3 A 12-hour-old infant who has been feeding poorly becomes tachypneic with
grunting. Which of the following initial tests has the lowest diagnostic yield?
A. Chest radiograph
B. Complete blood count
C. Urine culture
D. Blood culture
E. Glucose level
4.4 A 7-day-old infant is seen in the emergency department for fever and poor
feeding. The baby was delivered vaginally 2 hours after the mother arrived to
hospital. The delivery was a 36 weeks of gestation and the birth weight was
2900 g. Maternal laboratory test results were negative. The most likely organism causing this patient’s symptoms is:
A. Group B Streptococcus (GBS)
B. Listeria monocytogenes
C. Staphylococcus aureus
D. Streptococcus pneumoniae
E. Haemophilus influenza


4.1 E. Prematurity places this baby at greater risk for sepsis. Young maternal age,
low birth weight, rupture of membranes greater than 18 hours, initial Apgar
less than 5, and maternal fever are additional risk factors for sepsis.
4.2 D. This patient may have late-onset bacterial infection, likely GBS; she should
be admitted for sepsis evaluation and IV antibiotics. The best initial treatment
in this age group is broad-spectrum antibiotics such as ampicillin and cefotaxime. If cultures are positive for GBS, antibiotic therapy can be narrowed to
penicillin G.
4.3 C. Urine cultures are not usually obtained in the workup of early onset sepsis.
Urinary tract infections are rare in the first few days of life.
4.4 A. GBS is the most common pathogen to cause neonatal sepsis in infants
aged 0 to 3 months.