Germ-free delivery. The initiation of management of infants with a high probability of congenital immune deficiency states

Abstract

Germ-free delivery of an infant with a high probability of congenital severe combined immune deficiency disease was accomplished by cesarean section without major modification of routine medical and nursing procedures. The male sex of the infant had been determined by karyotype on amniotic fluid cells, thus the risk of being affected by an X-linked disease was established. Intensification of ordinary methods for preparation of operating area and personnel resulted in successful germ-free delivery. Highly technical equipment and specially trained people with attendant high cost were not required. The infant was placed in a sterile plastic flexible film isolator where he has been maintained in a gnotobiotic state for twelve months (to date) free of infection in spite of continued immune incompetence. With the likelihood that lesser forms of this disease may be more common than heretofore expected and with the advent of new obstetric and immunologic diagnostic techniques, sterile delivery may assume more importance in the future.