AN INFANT weighing 650 g was delivered by cesarean section at 25 weeks' gestation to a mother whose pregnancy was complicated by cervical incompetence and prolonged rupture of the membranes. There was no evidence of neonatal infection, and systemic antibiotics were discontinued after 48 hours. Respiratory distress syndrome was treated with mechanical ventilation and bovine surfactant followed by continuous nasal positive airway pressure. Serial cranial sonograms were normal. On day 35 of the child's hospitalization, an intravenous site on her right ankle became infiltrated. Despite aggressive local care, an ulcer developed over the lateral malleolus, and 2 days later the infant exhibited worsening respiratory distress and bowel ileus. Wound and blood cultures obtained grew Staphylococcus aureus.
Persistence of S aureus bacteremia despite intravenous antibiotic administration prompted closer scrutiny with imaging for occult foci of infection. Three days after the onset of sepsis (hospital day 38) a technetium Te 99mm bone