Icterus, Encephalopathy, and Galloping Neonatal Pneumonia

A 3,200-g male infant was delivered to a 29-year-old primigravida (0 positive) at 41 weeks' gestational age. Internal fetal monitoring was applied, and fetal heart rate deceleration was observed. A normal, spontaneous vaginal delivery occurred 2½ hours after rupture of the fetal membranes. Apgar scores were 8 and 9 at one and five minutes, respectively. No evidence of meconium staining was noted. The gestation was complicated by emesis gravidarum and a positive vaginal culture for group B Streptococcus one month before parturition. The mother was treated with erythromycin estolate for one week. A prenatal Papanicolaou smear disclosed no pathologic findings.

At admission to the routine nursery, this well-nourished, well-developed infant had normal vital signs and a lusty cry. He appeared alert and fed well at the breast. He had normal stools and voided regularly. Jaundice was visible on the second day, and the indirect serum bilirubin level measured 14.8 mg/dL