Distinguishing Intraventricular Hemorrhage From Infectious Etiologies in Febrile Late Preterm Neonates: Case Studies in Antibiotic Stewardship

Intraventricular hemorrhage (IVH) is a well-recognized complication in preterm infants, but its presentation as fever can be easily overlooked, leading to extensive sepsis workups and delayed diagnosis. This case report presents two late preterm infants who developed fever as the primary presenting symptom of IVH. Distinguishing IVH-related fever from that due to infectious causes can be challenging in this vulnerable population, where overuse of antimicrobials carries significant risks, including altered microbiome development, necrotizing enterocolitis, and antimicrobial resistance. Incorporating early diagnostic evaluation for IVH through cranial ultrasound in late preterm infants presenting with unexplained fever may avoid unnecessary tests and promote judicious antimicrobial use while improving overall neonatal outcomes.