S’s mother brought him to the local health clinic with concerns about high fever, poor feeding, and difficulty breathing. She also reports that S has been increasingly irritable and had an episode of convulsions earlier that day.

S was born at home via vaginal delivery after a full-term pregnancy. His mother did not receive regular antenatal care, and there were no immediate complications at birth. However, S has had poor feeding since the third day of life, and his mother noticed that he has become progressively more lethargic. There is a history of foul-smelling discharge from his umbilical stump since day five. S has not received any vaccinations yet.

Vitals: Temperature 38.5°C, heart rate 170 bpm, respiratory rate 65 breaths per minute, oxygen saturation 90%.

General Appearance: Irritable and lethargic, with poor muscle tone. Skin appears pale, with a rash on the abdomen.

Neurological Exam: S is irritable with hypertonia and a high-pitched cry. He has diminished sucking and Moro reflexes.

Respiratory Exam: Tachypneic with subcostal retractions, crackles heard in the lower lung fields.

Other Systems: Umbilical stump is erythematous with purulent discharge. The abdomen is soft with no organomegaly.

A full blood count showed elevated white blood cells with neutrophilia and a left shift, suggesting bacterial infection.

Blood cultures were taken to identify the causative organism.

Lumbar puncture revealed cloudy cerebrospinal fluid, with an elevated white cell count, high protein, and low glucose, consistent with bacterial meningitis.

Chest X-ray showed patchy infiltrates in both lower lung fields, indicating pneumonia.

S was diagnosed with neonatal sepsis, likely secondary to umbilical infection (omphalitis), complicated by pneumonia and meningitis.

1. Antibiotic Therapy: S was started on broad-spectrum intravenous antibiotics (ampicillin and gentamicin) to cover common pathogens, with plans to adjust based on culture results.
2. Supportive Care: Oxygen therapy was initiated to manage respiratory distress. Intravenous fluids were given to support hydration and correct electrolyte imbalances. Antipyretics were administered for fever control.
3. Monitoring: Close monitoring of vital signs, neurological status, and feeding patterns was initiated, with plans for continued care in the neonatal unit.
4. Education: S’s family was educated about the importance of timely treatment of infections and the need for follow-up to monitor for potential long-term complications, including developmental delays.

With prompt antibiotic therapy and supportive care, S’s prognosis is guarded but hopeful. However, delayed access to healthcare in rural areas of sub-Saharan Africa increases the risk of severe complications, such as neurological impairment from meningitis.