A preterm neonate delivered at 28 weeks gestation, mother had antenatal steroid. Blood counts showed leukemoid reaction, blood culture, procalcitonin and peripheral blood film was normal. Baby was stabilized in the NICU, recovered and the WBC count done serially showed a downward trend.  The leukemoid reaction was presumed to come from antenatal steroid use. The diagnostic and management challenges encountered in managing the infant in resource constrained environment like ours is presented alongside.