A term baby develops grunting, nasal flaring, and cyanosis within 24 hours of birth. The mother had prolonged rupture of membranes lasting 26 hours and intrapartum fever. Chest X-ray shows bilateral diffuse alveolar consolidation with air bronchograms. Blood culture grows gram-positive diplococci in chains. Which organism and empirical regimen fit this presentation?

• A Klebsiella pneumoniae, meropenem monotherapy
• B Staphylococcus aureus, cloxacillin plus gentamicin
• C Escherichia coli, cefotaxime plus amikacin
• D Group B Streptococcus, ampicillin plus gentamicin ✓

Explanation

Early-onset neonatal pneumonia presenting within the first day of life, associated with prolonged rupture of membranes and maternal fever, is classically caused by group B Streptococcus, a gram-positive diplococcus in chains. Standard empirical therapy is ampicillin combined with gentamicin until cultures guide de-escalation. Gram-negative rods such as E. coli appear as bacilli on smear and typically follow different risk profiles.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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