Background: Early onset neonatal sepsis contributes substantially to neonatal morbidity and mortality. Presenting signs and symptoms vary, and most causes are due to a limited number of common microbes. However, providers must also be cognizant of unusual pathogens when treating early onset sepsis. Case description: We report a case of a term neonate who presented with respiratory distress, lethargy, and hypoglycemia 5 hours after birth. He was treated for presumed early onset sepsis with blood culture revealing an unusual pathogen: Pasteurella multocida. Sepsis from this pathogen is a rarely reported cause of early onset neonatal sepsis. Our report is one of few that implicates vertical transmission with molecular diagnostic confirmation of Pasteurella multocida, subspecies septica. The neonate was treated with antibiotics and supportive care and recovered without ongoing complications. Conclusions: Providers should maintain an index of suspicion for rare causes of neonatal early onset sepsis. For these unusual cases, precise microbial identification enables understanding to provide best clinical care and anticipation of complications.

The aim of the study is to analyze whether repeat testing is necessary in healthy children presenting to a pediatric emergency department (ED) who are found to have hyperkalemia on a hemolyzed specimen. Methods:A 5-year retrospective analysis of pediatric ED patients found to have elevated potassium values on laboratory testing of a sample reported to be hemolyzed. All patients aged 0 to 17 years who had an elevated potassium level after an intravenous draw resulted from a serum sample that was reported as hemolyzed during an ED visit were included in the study.Results: One hundred eighty-seven patients with some degree of both hemolysis and hyperkalemia were included in the final analysis. The median age was 1.9 years of age. The most common race among all patients was White, followed by African American, and Asian. One hundred forty-five children had repeat sampling for hemolyzed hyperkalemia, 142 children, 97.9% (95% confidence interval, 95.6%-100%) had a normal potassium on repeat and 3 children, 2.1% (95% confidence interval, 0.0%-4.4%) had true hyperkalemia. The frequency of true hyperkalemia in our study population was 2% (3/145). All 3 of these patients had underlying conditions that would appropriately have raised clinician suspicion for hyperkalemia.Conclusions: It may be unnecessary to obtain repeat samples to confirm normal potassium in a hemolyzed sample with normal blood urea nitrogen and creatinine.