A baby girl was born at 23+4 weeks by precipitate delivery following spontaneous onset of labour and PROM of 121 hours. Mum had received a course of antenatal steroids. Following two unsuccessful trials of extubation on day 7 and 12, she had a significant cardio respiratory deterioration on day 14. She was started on second line antibiotics. Her CRP went up to 20 and her
platelet count dropped to 51. Her chest x ray showed a large bullous emphysematous lesion occupying almost all of her right middle
lobe (Figure 1 & 2). She became increasingly difficult to ventilate with worsening acidosis, hypotension and hyperglycemia despite maximizing intensive care support. Following discussion with her parents, her care was redirected to a palliative course. Post mortem examination of lungs revealed widespread collections of neutrophils / abscesses consistent with congenital pneumonia with abscess (seen as cavitating lesion on imaging). Her blood cultures did not reveal any growth.
Neonatal lung abscess is very rare  and is often of multibacterial etiology [2,3]. Predisposing factors include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by percutaneous needle aspiration under either ultrasound  or CT guidance  is recommended to direct early appropriate intravenous medical therapy and hasten recovery, prevent further complications and obviate the need for surgery .