Renal ultrasound imaging in a preterm infant with a persistently elevated C reactive protein

Description 

A preterm infant born at 25+5 weeks gestation was being treated for late onset sepsis on day 30. She had just recovered from an episode of necrotising enterocolitis, requiring a 14-day course of intravenous antibiotics. She was on biphasic non-invasive respiratory support and fully enterally fed on expressed breast milk. During this time, she was noted to have a rising C reactive protein (to maximum of 114 mg/L), high white cell count (highest count 26.2x10⁹/L) and thrombocytopaenia (lowest count 63x10⁹/L), in spite of being treated with second-line intravenous broad-spectrum antibiotics (meropenem and vancomycin) for 14 days. She did not receive antifungal prophylaxis during her admission. Blood and cerebrospinal fluid cultures showed no growth. Urinalysis showed no growth on bacterial and fungal culture and no filamentous fungi were noted on microscopy. She remained clinically well. A cranial and abdominal ultrasound scan was  undertaken on day 35. The abdominal ultrasound revealed a...

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