Skin rash in a preterm infant

A girl was born at 30 weeks of gestation by spontaneous vertex delivery. The pregnancy had been uneventful apart from detection of group B streptococcus at nine weeks of gestation. This was treated with a course of oral ampicillin for five days.

Although the mother’s membranes ruptured 26 hours before delivery, she remained well throughout labour (which lasted for one hour) and there were no signs of infection. The baby’s birth weight was 1440 g and she had Apgar scores of 9 and 10 at one and five minutes, respectively. Although she showed no signs of sepsis, because of the history of prolonged rupture of membranes, a septic screen was performed and she was started on intravenous amoxicillin and cefotaxime for 48 hours until the cultures were confirmed as negative; C reactive protein (CRP) and peripheral white cell count remained normal during this time. She needed supplemental oxygen, via nasal continuous positive airway pressure, for three days because of surfactant deficiency related respiratory distress syndrome. When she was 6 days old, she developed recurrent apnoea associated with oxygen desaturations, which required endotracheal intubation. Her chest radiograph was normal. A repeat septic screen was performed, including analysis of cerebrospinal fluid and further blood cultures, and she was started on cefotaxime and teicoplanin. Her blood CRP remained normal throughout and the cerebrospinal fluid sample (day 7) and postnatal blood cultures (days 1, 7, and 9) were all negative for bacterial infection.

At 9 days of age she developed 3-5 mm vesicular skin lesions, mainly on her face and chest. She continued to have further eruptions on her trunk and a few lesions on the hard palate during the second week. The skin lesions progressed from being clear vesicles to pustules, and during the …