Fulminant urosepsis and postrenal acute renal failure

He was circumcised on the second day of life with Plastibell device (Hollister, Libertyville, IL, USA) and discharged to home. On presentation to the ED, patient's weight was 2.83 kg, rectal temperature 37.83℃, heart rate 162 beats/min, respiratory rate 88 breaths/min, and pulse oximetry 97% on room air. He had a weak cry, scleral and cutaneous icterus, and marked abdominal distention with bilateral palpable renal masses. The Plastibell device was adherent to a very edematous glans penis with visible membrane occlusion of the urethra, and the penile skin above the device was necrotic.

Patient had significant respiratory distress and became bradypneic and hence was intubated and placed on mechanical ventilation.

Patient remained thrombocytopenic and was transfused with platelets when the count decreased to 15,000/µL. His hemoglobin decreased to 7.4 g/dL after hydration and blood loss following central venous line and arterial line catheterization. He received packed red blood cell transfusion. Patient was extubated on the third day of hospitalization and at this time urine output decreased to 3 mL/kg/hr and creatinine was 0.38 mg/dL. On the seventh day of hospitalization, patient was febrile and grew E. coli from the blood again after a previous negative blood culture

Our patient developed urethral obstruction and subsequently hydronephrosis, acute renal failure, fulminant E.coli sepsis with disseminated intravascular coagulation and respiratory failure that required mechanical ventilation and aggressive fluid resuscitation in less than 48 hours from impaction of the Plastibell device. Furthermore, the acute and rapid onset of urosepsis led to pyelonephritis in our patient. Such complications could be fatal in a 4 day old neonate.