The significance of positive blood culturesin newborn infants

Abstract

I T IS not uncommon nursery experience to observe certain newborn infants who regularly lose weight beyond the usual expected time and who exhibit a lack of interest in nursing regardless of type of feeding. More often than not careful examination reveals no very convincing reason for the anorexia, listlessness, and accompanying weight loss. If allowed to go unchecked, loss of weight may be very considerable, and energetic and supportive t reatment becomes imperative. The writers observed a suggested relationship between this clinical picture and blood cultures which were quite regularly positive for hemolytic staphylococci. In August, 1946, a study was begun for the purpose of clarifying this clinical impression. This report is concerned with 323 blood culture samples taken from 240 infants, some of whom presented with surprising' regularity the above clinical picture. In others the nursery course was uneventful. The number of blood cultures and the number of infants included in this study would seem to be significant. In a partial review of the literature we find scant reference to bacteremia in the newborn infant. Older references to sepsis of the newborn infant are in most instances confusing and lacking in adequate blood studies. Usually these older reports described a severe type of illness, with death the usual rule, characterized by fever, severe gastrointestinal disturbance, jaundice, hemorrhage, and serious lesions noted at autopsy in the various body systems. The most informative study and the one most regularly referred to is that of Dunham. 1 She reported the findings in thirty-nine eases of septicemia of the newborn infant collected from the records of the New Haven Hospital and occurring over a period of five years. In thirty-four of her eases the diagnosis was made from blood cultures taken before death. She fur ther recorded the findings in 115 blood cultures taken at random from forty-nine apparently healthy newborn infants. Staphylococcus albus was recovered in thirty-five instances from these apparently well infants. Dunham concluded tha t Staph. albus, since it could regularly be cultured from the skin of newborn infants, should not be considered as a cause of illness but rather as a skin contaminant when present in blood cultures in the neonatM period. This conclusion has been generally accepted as a fact'. The data recorded in this study suggest that hemolytic Staph. albus is capable of invading, the blood stream of newborn infants with surprising regularity, and, if present in sufficient nmnbers, may cause regular and marked weight loss and at times serious signs of illness.