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gravely ill with apnea, bradycardia, hypothermia, bradypnea, or seizures.
However, a careful physical examination suggests abuse rather than sepsis.
Bruises may be present on the body, though more often, no external evidence of
trauma is present. Respiratory distress without stridor or lower airway sounds
may be due to central nervous system dysfunction. The head circumference is
often at or above the 90th percentile, and the fontanel may be full or bulging.
Retinal hemorrhages are often found and strongly suggest intracranial
hemorrhage from trauma. Some neurologic signs may be confused with
meningitis, such as nuchal rigidity, irritability, coma, seizures, or posturing.
Although the CBC often shows a leukocytosis and thus is confusing, the spinal
fluid from a shaken baby is usually bloody and fails to clear as the fluid is
collected. A noncontrast CT scan or magnetic resonance imaging (MRI) usually
demonstrates a small posterior, interhemispheric subdural hematoma. Such
shaken babies have a high incidence of serious morbidity and mortality.

EVALUATION AND DECISION
Presume that any infant who is critically ill in the first few weeks of life may be
septic. It is imperative to stabilize the baby rapidly ( Fig. 73.1 ) because this lifethreatening situation may respond to early treatment. Restore airway, breathing,
and circulation and obtain vascular access. Intraosseous access should be used if
IV access cannot be obtained rapidly, and the patient may require vigorous fluid
resuscitation. Perform rapid bedside testing for glucose. Unless another diagnosis
is immediately obvious, it is best to give intravenous antibiotics while pursuing
alternative diagnoses. If time permits, send cultures to the laboratory before
giving antibiotics. Administer prostaglandins if cardiogenic shock with PDA
closure is suspected.