NEONATAL PURPURA FULMINANS DUE TO HOMOZYGOUS PROTEIN C DEFICIENCY

Severe and recurrent purpura fulminans developed in a Turkish boy at 1 week of age. Initial coagulation studies performed were compatible with disseminated intravascular coagulation. Subsequent investigations showed that the patient had homozygous and his healthy parents had heterozygous protein C deficiency. The episodes of purpura fulminans were controlled by infusions of fresh frozen plasma and heparinization. Oral anticoagulant therapy was given in the symptom-free period.     

NEONATAL SEPSIS DUE TO GROUP G STREPTOCOCCI

Abstract. Appelbaum, P. C., Friedman, Z., Fairbrother, P. F., Hellmann, J. and Hallgren, E. J. (Departments of Pathology, Paediatrics, and Obstetrics and Gynaecology, Hershey Medical Center, Hershey, Pennsylvania, USA). Neonatal sepsis due to group G streptococci. Acta Paediatr Scand, 69: 559, 1980.—Two cases of neonatal septicaemia due to group G streptococci ( Streptococcus canis ) are described. In one patient, infection coexisted with transient neonatal hyperthyroidism, while, in the other, concomitant group G streptococcal septicaemia and endometritis in the mother was seen. Group G streptococci are rare causes of infection, especially in the paediatric age group. Bacteria were identified by serological and biochemical methods. Both neonates responded well to penicillin therapy, but the maternal infection required combination therapy with penicillin G, gentamicin, and chloramphenicol. The literature on systemic group G streptococcal infection is briefly reviewed. With increasing use of serotyping in the identification of β-haemolytic streptococci, non-group A organisms will probably be identified more frequently from neonatal and other infections.     

GROUP B STREPTOCOCCAL INFECTION IN THE NEWBORN Criteria for Early Detection and Treatment

Abstract. Recent reports indicate that the group B haemolytic streptococcus has now assumed a major role in neonatal septicaemia in the United Kingdom. Of particular concern are the absence of premonitory signs, the fulminating nature of the infection and the high mortality. 31 cases from which this organism was isolated during the first week of life included 5 cases of neonatal septicaemia, 4 of which proved fatal. An attempt was made ( a ) to identify the group of neonates at greatest risk and ( b ) to formulate guidelines for early detection and treatment. Study indicates the importance of apnoea as a sign of infection particularly in those infants who are preterm, of low birth weight and asphyxiated. There is need for aggressive bacteriological screening and early administration of antibiotics to prevent the high mortality from group B streptococcal infection.     

Trend of neonatal group B streptococcal infection during the last 15 years

BACKGROUND: The survey was designed to determine the trend of group B streptococcal (GBS) infection during the last 15 years, as well as update the reality of this disease. METHODS: Questionnaires were administered every 5 years towards neonatal intensive care unit-equipped hospitals. The first survey was made from 1983 to 1987, the second one from 1988 to 1992 and the third one from 1993 to 1997. The 15-year questionnaire survey included a total of 831 patients. The changes in number of patients, the ages at onset, the diagnosis, the serotypes of causative agents, the presence or absence of complicated delivery and the prognosis were analyzed. RESULTS: It seems that the increasing trend of the number of patients has stopped in the period from 1993 to 1997 (third survey). The most common causative subtype was type III GBS, regardless of early onset type or late onset type. As to perinatal abnormality, approximately 40% of the early onset cases were free from risk factors. Concerning the prognosis, 22.6% of early onset cases and 38.7% of late onset cases died or had sequelae. CONCLUSIONS: The number of GBS-infected cases has stopped increasing, but it is still necessary to carry out screenings of pregnant women for the purpose of decreasing the onset of the disease.     

NEONATAL SEPTICEMIA AND PERINATAL RISK FACTORS

Abstract. Many methods for screening and prediction of neonatal septicemia have been tried. In this study a score, related to both perinatal risk factors and neonatal diseases, was tested upon healthy newborn infants, infants with septicemia and infants with other diseases. Statistical differences were found between infants with neonatal septicemia and infants with other neonatal diseases as well as normal newborns. It was also possible to find a relationship between certain predisposing factors and predominance of certain pathogens. Complications during pregnancy and delivery were most often found in the group B streptococcal, combinations of invasive procedures and neonatal diseases in the staphylococcal group and surgical procedures in the gram-negative group.     

Neonatal Group B Streptococcal Septicaemia in a Developing Country

ABSTRACT. During a 3-year study at the neonatal intensive care unit, University Hospital of the West Indies, the incidence of group B streptococcal (GBS) septicaemia was 13.6/1000 admissions and 1.4/1000 live births. GBS accounted for 35% of blood culture isolates and was the most frequent cause of septicaemia. Underlying disease or other possible predisposing factors were identified in 16 of 25 neonates with GBS septicaemia. Comparison of early onset and late onset disease indicated an increased incidence of prematurity, prolonged rupture of membranes, and respiratory distress in the former and a predominance of meningitis associated cases in the latter. Mortality was 50% for early onset cases, 29% for late onset cases and 36% overall. Antimicrobial therapy and preventive measures which may be appropriate for a developing country are discussed.     

新生儿晚发型B族链球菌败血症临床特征及预后分析

目的探讨晚发型B族链球菌（GBS）败血症的临床特征及预后情况。方法回顾性分析新生儿重症监护室（NICU）2007年1月-2011年12月出院诊断晚发型GBS败血症的15例新生儿以及同期出院诊断为晚发型非GBS革兰阳性菌败血症34例新生儿的临床资料。结果晚发型GBS败血症与晚发型非GBS革兰阳性菌败血症新生儿在气促、抽搐和呼吸暂停等临床表现方面,差异有统计学意义（P均<0.05）。晚发型GBS败血症组脑脊液白细胞计数>100×106/L、超敏C反应蛋白>100 mg/L及脑脊液葡萄糖<3.11 mmol/L的比例高于非GBS革兰阳性菌败血症组（P<0.05）。GBS对青霉素、氨苄青霉素、头孢曲松、哌拉西林/他唑巴坦、左氧氟沙星、万古霉素敏感,对红霉素及庆大霉素耐药率均为87.5%。晚发型GBS败血症与非GBS革兰阳性菌败血症患儿在并发脑膜炎及脑积水、脑室管炎等后遗症的差异也有统计学意义（P<0.05）,但病死率的差异无统计学意义（P>0.05）。结论晚发型GBS败血症起病较隐匿,症状不典型,并发症多,且易有后遗症;对可疑GBS败血症新生儿应早期使用有效抗生素治疗。     

Prevention of early onset group B streptococcal sepsis in the newborn

: There is an urgent need for strategies to prevent early onset group B streptococcal sepsis in the newborn. The most effective mechanism is the identification of maternal carriers of the organism and interruption of transmission during labour. Vaginal culture is currently the most reliable method for the identification of carriers. Antibiotic prophylaxis for known carriers in labour has been demonstrated to be effective as standard management practice in a number of Australian institutions and is the best available strategy at this stage.     

GROUP B STREPTOCOCCAL COLONIZATION OF PREGNANT WOMEN AND THEIR NEONATES Epidemiological Study and Controlled Trial of Prophylactic Treatment of the Newborn

Abstract. Colonization with group B streptococci of the genital tract was studied in 1115 women during the last trimester of pregnancy. 76 or 6.82 % were found to harbour this bacterium. The incidence of contamination was significantly higher among Belgian women than among parturients of Mediterranean origin ( p < 0.001). It was also more frequent in primigravidae ( p <0.05) and in the poorer (0.10 < p > 0.05). At the time of admission in the delivery room, it was noticed that rupture of the amniotic membranes for more than 24 hours was more often associated with group B streptococcal carriage by the mother ( p <0.001). 29 out of 68 (42.6%) infants born to group B streptococci positive mothers were colonized at birth. 67 of them were submitted to a controlled trial of immediate versus delayed penicillin therapy. 44.8 % and 42.1 % of the neonates were contaminated at birth in each group of treatment respectively. No instance of group B streptococcal infection developed in either group. This suggests that immediate therapy with penicillin of infants of group B streptococci positive mothers has no definite advantage upon delayed treatment.     

MODIFIED HUMAN IMMUNE SERUM GLOBULIN FOR INTRAVENOUS ADMINISTRATION: IN VITRO OPSONIC ACTIVITY AND IN VIVO PROTECTION AGAINST GROUP B STREPTOCOCCAL DISEASE IN SUCKLING RATS

ABSTRACT. Human immune serum globulin (ISG) preparations were tested in an in vivo suckling rat protection assay and an in vitro opsonophagocytic assay against various types and strains of Group B streptococci (GBS). Standard ISG provided minimal protection in suckling rats against type III GBS sepsis, whereas preparations of ISG modified for intravenous administration (MISG) provided significant protection against all strains of type III, type II and type Ia GBS tested. Although less protection was obtained against type la strains, the survival in suckling rats challenged with all types of GBS varied from 73 % to 91% with MISG therapy, as compared with 5% to 12% survival in untreated animals. In this in vivo model, MISG was protective even when administered after bacterial challenge, but had to be administered within 5 h of infection. MISG also had high in vitro opsonic activity against GBS types III and II, but was less effective with some type Ia strains. Just as MISG was more protective than ISG in vivo, it also was more opsonic in vitro. A detailed comparison of one lot of MISG with its parent ISG revealed that the modified preparation actually contained less IgG. When equivalent concentrations of affinity-purified IgG from both preparations were tested, the IgG from MISG was significantly more opsonic. Since the affinity purification procedure eliminated the possibility that IgM or substances introduced in the modification process were actually responsible for the enhanced bactericidal activity, it appears that the individual IgG molecules in MISG may be more effective. These studies suggest that MISG which has been modified by reduction and alkylation for intravenous administration may provide a valuable adjunct to chemotherapy in the treatment of GBS disease in the neonate.     

Early-onset neonatal group B streptococcal infections in New Zealand 1998-1999

OBJECTIVE: To determine in New Zealand infants the attack rates, risk factors, preventive policies, strain serotype and antibiotic susceptibilities of early-onset neonatal group B streptococcus (GBS) infection. METHOD: A 2-year prospective active surveillance study was conducted in New Zealand's 19 neonatal units. Cases had to present within 48 h of delivery, be unwell, possess abnormal haematological indices and have GBS isolated from sterile sites. RESULTS: Of the 112 402 infants born in New Zealand during 1998-1999, 56 had early-onset GBS infection, an attack rate of 0.5 per 1000 live births (95% confidence interval [CI] 0.38, 0.65). Seven had meningitis and there was one death (case fatality rate of 1.8%; upper 95% CI 9.5%). Univariate analysis identified young maternal age, parity, preterm labour, prolonged membrane rupture, maternal fever and assisted delivery as risk factors. Preventive policies for GBS were reported by 14 (74%) obstetric centres associated with neonatal units. Of the 56 cases, five (9%) were born to mothers receiving intrapartum antibiotics, 32 (57%) had mothers with risk factors but were not treated with antibiotics, and 19 (34%) were born to mothers without identifiable risk factors for GBS prevention. Serotypes Ia and III predominated, while two isolates were resistant to erythromycin and/or clindamycin. CONCLUSIONS: Rates of early-onset GBS infection are similar to other countries following the introduction of prevention policies. Further reductions are possible with full implementation of these guidelines. Meanwhile, emergence of antibiotic resistance complicates the management of women with penicillin allergy. Vaccine development therefore remains a priority.     

Prevention of neonatal group B streptococcus disease in the 21st century

There have been significant reductions in early-onset neonatal group B streptococcus (GBS) disease following implementation of maternal intrapartum antibiotic prophylaxis (IAP) policies. Nevertheless, GBS remains a leading cause of neonatal sepsis in Australia and New Zealand resulting in considerable morbidity and mortality, particularly among preterm infants. In the United States, the universal screening-based approach for identifying women for IAP results in apparently lower rates of early-onset neonatal GBS infection than risk-based assessment. In addition, IAP has altered the profile of newborn infants who develop early-onset disease. Many affected infants lack the typical intrapartum risk factors for GBS infection, are born to mothers with a negative GBS screen or represent missed opportunities for prevention. Clinicians should remain alert for signs of sepsis in any newborn infant. We provide an update of GBS preventative management strategies in the perinatal period taking into account recent United States, Australian and New Zealand guidelines.