Late-Onset Sepsis in the Periviable Neonate

A female infant born at 23 0/7 weeks' gestation with a birth weight of 570 g was admitted to the NICU due to extreme prematurity, extremely low birth weight, and respiratory distress syndrome. At approximately 2 weeks of life, she underwent an evaluation for late-onset sepsis because of escalating respiratory support requirements. Empiric antibiotics were initiated while awaiting culture results. Sequential broadening of antibiotic coverage occurred in response to worsening clinical status. Despite maximal medical therapy, the infant continued to deteriorate and ultimately died following an acute bradycardic/desaturation event requiring CPR. Blood culture results returned after her death revealed Gram-negative bacteremia. This case emphasizes the treatment challenges of late-onset sepsis in periviable infants, in whom rapid decompensation from infection can occur even with aggressive antimicrobial therapy.