‘Thank you.’ She took the proffered file. ‘You’re due a break, aren’t you?’
That comment about locums still rankled: no way was he going to go off duty for even a second before his shift ended. ‘Doesn’t matter,’ he said.
‘Actually, it does,’ Claire said, surprising him. ‘The special care baby unit’s a high-pressure environment, so you need regular breaks to recharge your batteries.’ She gave him a half-smile that made his heart rate speed up a notch. ‘I don’t crack the whip that hard on my staff.’
‘Regular dragon is our Claire,’ Tilly said with a grin.
Claire pulled a face at her. ‘Yeah, right. I have a patient to see. Catch you later.’
‘Her bark’s worse than her bite,’ Tilly told Eliot.
‘I didn’t think dragons barked,’ Eliot said drily.
Tilly chuckled. ‘This one does. Seriously, Eliot, don’t take any notice if she growls at you. Claire’s great. She backs her staff to the hilt—no politics where she’s concerned, because the patients come first, last and always. So how long are you with us?’
‘Until Kelly comes back,’ he said, referring to the doctor he was filling in for while she was on maternity leave. Unless...But no. He wasn’t going to tempt fate and think up problems. Be positive, he told himself. Fran was going to stay and Ryan was going to be just fine.
* * *
Some time later, Eliot was called down to the maternity ward to look at one of the newborns. ‘I’m not happy about this little one,’ Shannon told him. ‘Ricky Peters—he’s twenty hours old, a thirty-seven-weeker, weight a shade under six pounds. He’s his mum’s first baby. No problems in the pregnancy, though she had a bit of a long labour and she needed a ventouse at the end.’
‘What was his Apgar score?’ Eliot asked. The Apgar score was a way of classifying the baby’s condition one minute and five minutes after birth—relating to the baby’s breathing, heart rate, colour, muscle tone and reaction to stimulation. A high score usually meant that the baby would be fine.
‘Six, at five minutes,’ Shannon said.
Not quite as good as Eliot had hoped—he’d really wanted a nine or ten—but not that bad either. ‘What are his symptoms?’ Eliot asked.
‘That’s just it. I can’t put my finger on it—I just know that something isn’t right. He’s a bit sleepy, which I know you’d expect in an early baby, but he’s not feeding as well as he was earlier.’
Shannon’s badge proclaimed she was a senior midwife. Eliot decided to trust her instincts.
‘Mum’s temperature is up a bit, too,’ Shannon said.
A bell rang in the back of Eliot’s head. Maternal fever...‘Did she have group B strep during pregnancy?’ he asked.
Shannon looked through the notes. ‘She wasn’t tested, according to this.’
And even if she had been, Eliot knew that the test was unreliable, with a fifty per cent false negative result. ‘Let’s have a look at him,’ Eliot said.
Shannon introduced him to Leona Peters, and Eliot duly admired the baby. ‘Well done, you. He’s gorgeous,’ he said, cuddling the baby.
‘My hubby says he looks like a Martian with that pointed head,’ Leona said wryly.
‘So do all ventouse babies—but it doesn’t last. His head’ll be back to normal before you know it,’ Eliot reassured her. ‘Right, then, little one, let’s see how you’re doing.’ The baby’s heart rate was a bit on the high side for Eliot’s liking, and the baby was breathing fast and ‘grunting’ slightly. Ricky was also slightly irritable during the examination, and the warning bell in the back of Eliot’s head grew stronger.
‘I’d like to do a few tests, Mrs Peters—just to rule out a couple of things that might be brewing,’ he said. ‘I’d like to take him up to my ward—the neonatal unit—to warm him up a bit.’
Leona looked alarmed. ‘Special Care, you mean? How long will he be there?’
‘It shouldn’t be too long. And you’re very welcome to come with him,’ Eliot said. He knew it was the ward policy to encourage bonding between parents and babies.
She nodded. ‘I wondered if he was coming down with a cold. I feel a bit groggy at the moment, and there’s been a filthy summer cold going round at home.’
‘Could be.’ It could also be something a lot more serious, but Eliot decided not to worry her just yet. ‘If it is a virus, it’d be handy to know what it is, so I’ll ask Shannon to do a couple of tests on you before you come up, if that’s all right.’
He wrapped the baby gently in a blanket. ‘Have you got a spare hat, Shannon, and some oxygen to keep him going until I’m upstairs? And could you ring up to Tilly to tell her to expect us?’
‘Sure.’ Shannon returned a couple of minutes later with the oxygen and a hat. ‘Could I ask you to give Mrs Peters a swab, please?’ he asked. Roughly one in a thousand babies were born with a group B streptococcal infection, and the numbers were increasing. He lowered his voice slightly. ‘I’m a bit concerned about GBS, so I’d like a high vaginal swab, please.’
‘Rightio,’ Shannon said. ‘I’ll bring Leona up to you when we’ve finished down here.’
‘Thanks.’ He smiled at her and took Ricky up to the neonatal unit.
‘Tilly said you had a suspected GBS,’ Claire said, coming over to the cubicle just as Eliot settled the baby into the cot.
Eliot nodded. ‘He’s lethargic, he’s not feeding properly—even though the first couple of times at the breast were fine—his heart rate’s a bit on the high side, he’s grunting and his temperature’s up. I know it could be RDS—’ RDS, or respiratory distress syndrome, was common in early babies ‘—but at this stage it’s too early to tell if it’s that or something else. The mum’s got a temperature, too.’
‘What’s his blood pressure?’
Eliot checked. ‘Low. And his breathing’s fast. I’ve asked Shannon on Maternity to give the mum a swab for group B strep—there weren’t any indications in the notes.’
‘Three out of ten pregnant women have group B strep without any symptoms, and the only reliable test is the enrichment culture method—which isn’t widely available,’ Claire said. ‘So if there weren’t any indications to give her antibiotics in labour, the baby could have picked it up as he came through the birth canal. I take it that it was a normal delivery, not a section?’
‘Ventouse,’ Eliot said. ‘So I don’t want to take any chances. If it is group B strep, time isn’t on our side. I’ll get bloods done, a lumbar puncture and an X-ray, but I don’t want to wait for a culture. I think we should start him on antibiotics now. Penicillin for group B strep and gentamycin in case it’s pneumococcus.’
Claire nodded. Sepsis could suddenly become overwhelming in tiny babies, and if the sepsis was untreated there was a fifty per cent risk of the baby dying. If the lumbar puncture results were clear, they could discontinue antibiotics in forty-eight hours. ‘We need to keep a really close eye on him in the next two days in case it turns into pneumonia or meningitis. Is the mum coming up?’
‘When she’s had her swab.’
‘Good. Do you want me to talk to her about the possibility of group B strep?’ Claire asked.
‘No, I’ll do it,’ Eliot said. ‘But if you’re offering...’
‘You want me to do the lumbar puncture?’ Claire guessed.
He nodded. ‘I really hate doing them.’