Etiology Of Neonatal Sepsis Research Articles

Beyond Early- and Late-onset Neonatal Sepsis Definitions: What are the Current Causes of Neonatal Sepsis Globally? A Systematic Review and Meta-analysis of the Evidence.

Sepsis remains a leading cause of neonatal mortality, particularly in low- and lower-middle-income countries (LLMIC). In the context of rising antimicrobial resistance, the etiology of neonatal sepsis is evolving, potentially making currently-recommended empirical treatment guidelines less effective. We performed a systematic review and meta-analysis to evaluate the contemporary bacterial pathogens responsible for early-onset sepsis (EOS) and late-onset neonatal sepsis (LOS) to ascertain if historical classifications-that guide empirical therapy recommendations based on assumptions around causative pathogens-may be outdated. We analyzed 48 articles incorporating 757,427 blood and cerebrospinal fluid samples collected from 311,359 neonates across 25 countries, to evaluate 4347 significant bacteria in a random-effects meta-analysis. This revealed gram-negative bacteria were now the predominant cause of both EOS (53%, 2301/4347) and LOS (71%, 2765/3894) globally. In LLMICs, the predominant cause of EOS was Klebsiella spp. (31.7%, 95% CI: 24.1-39.7%) followed by Staphylococcus aureus (17.5%, 95% CI: 8.5 to 28.4%), in marked contrast to the Streptococcus agalactiae burden seen in high-income healthcare settings. Our results reveal clear evidence that the current definitions of EOS and LOS sepsis are outdated, particularly in LLMICs. These outdated definitions may be guiding inappropriate empirical antibiotic prescribing that inadequately covers the causative pathogens responsible for neonatal sepsis globally. Harmonizing sepsis definitions across neonates, children and adults will enable a more acurate comparison of the epidemiology of sepsis in each age group and will enhance knowledge regarding the true morbidity and mortality burden of neonatal sepsis.

Profile: Maternal and Child Health Surveillance System in peri-urban areas of Karachi, Pakistan

A Maternal and Child Health Surveillance System (MCHSS) was set up by the department of pediatrics and child health, Aga Khan University, Pakistan in peri-urban areas of Karachi to provide a platform for various research projects. It was established in five low-socioeconomic communities in a stepwise manner between 2003 and 2014. The total area currently under surveillance is 18.6 km2 covering a population of 302,944. We maintain a record of all births, deaths, pregnancies, and migration events by two monthly household visits. Verbal autopsies for stillbirths, deaths of children under the age of five years and adult female deaths are also conducted. For over a decade, the MCHSS has been a platform for a variety of studies describing the burden of various infectious diseases like typhoid, pneumonia and diarrhea, evaluation of effectiveness of various treatment regimens for neonatal sepsis, assessment of the acceptance of hospitalized care, determination of the etiology of moderate to severe diarrhea, assessment of burden and etiology of neonatal sepsis and a multi-center cohort study measuring the burden of stillbirths, neonatal and maternal deaths. More recently we have also established a bio-repository of the well-characterized maternal and newborn cohort. Through a well-established MCHSS, we aim to provide concrete evidence base to guide policy makers to make informed decisions at local, national, and international levels.

The levels of Human Beta Defensin-2 (HBD-2) in premature neonates’ feces at Saiful Anwar Hospital, Malang, Indonesia

Background: Clinical evidence shows that the etiology of neonatal sepsis is translocation of the digestive tract of premature neonates. Human ß-defensor 2 has a protective effect during inflammation and apoptosis. This study aimed to determine the levels of fecal human ß-defensus-2 (HBD-2) as an inflammatory biomarker in premature neonates related to nutrition consumption.
 Methods: A cohort study design used in thirty-nine premature neonates according to inclusion criteria were collected in January to March 2019 in the neonatology room of RSUD Dr. Saiful Anwar Malang. The levels of premature neonatal feces HBD-2 were taken from all three sample groups on the seventh and fourteenth days and measured by the ELISA method. Data were analyzed using SPSS version 20 for Windows.
 Results: The mean levels of HBD-2 premature neonatal feces consuming formula milk alone were higher than other groups (349.16 + 67.66 vs 330.24 + 44.08 vs 215.65 + 51.34). There is a relationship between levels of HBD-2 premature neonatal feces with only breastfeeding (p=0,005; r=0.731), breast milk (p=0,005; r=0,727) and, formula milk only (p=0,003; r=0,761).
 Conclusion: The levels of HBD-2 in premature neonatal stools who consuming formula milk alone were significantly higher than levels of human HBD-2 premature neonatal stools that consumed only breast milk.

Microbiologic Etiology and Infant Factors Associated with Early Onset Neonatal Bacteremia at the Mount Sinai Hospital

Background/Rationale: Early-onset neonatal sepsis (EOS) is often acquired through vertical transmission and is an important cause of morbidity and mortality in infants. The etiology of neonatal sepsis has changed over time, and the intrapartum management of women at risk for infection has been shown to improve neonatal outcomes. Hypothesis or Research Question: To identify the microbiologic etiology of organisms causing EOS and evaluate the impact of maternal illness, labor and delivery practices, and postnatal factors on EOS rates at Mount Sinai Hospital (MSH). Study Design/Methods: An IRB approved descriptive retrospective chart review of cases of EOS in infants less than 7 days of age at MSH from 2015–2018 was conducted. A total of 41 infants were identified. Clinical charts were reviewed and classified into two groups based on age at time of presentation: very early onset sepsis (VEOS) (age days 0–2) and delayed early onset sepsis (DEOS) (age days 3–7). Corresponding maternal charts were also reviewed to identify obstetric risk factors and whether at-risk mothers received appropriate intrapartum prophylaxis. Results: In the VEOS group, 41% of cases were caused by Group B Streptococcus (GBS), 30% by E.coli, and 18% by other Streptococci. In the DEOS group, 33% of cases were coagulase-negative Staphylococci, 27% E.coli, and 20% S. aureus. There were no cases of GBS among the DEOS group. On average, VEOS occurred in term infants (37.40 ± 4.41 weeks) with a normal weight (2840 ± 88g), while DEOS occurred in preterm infants (30.74 ± 6.08 weeks) with a low birth weight (1550 ± 104g). 36.4% of GBS isolates demonstrated resistance to clindamycin. E.coli isolates demonstrated resistance to ampicillin/sulbactam (66.7%), co-trimoxazole (41.7%), and gentamicin (35%). No extended spectrum beta-lactamase-producing E.coli isolates were found in the VEOS or DEOS groups. Within the GBS EOS cases, 63.6% of infants who developed GBS EOS were born to women with a documented GBS negative screening test. Conclusions/Future Plans: The microbiologic etiology of VEOS and DEOS varied, with GBS only identified in the VEOS group and E.coli common in both the VEOS and DEOS groups. The failure to identify GBS colonization in women who give birth to infants that develop GBS EOS requires further exploration. Our study demonstrates the need for both strategies to reduce the risk of E.coli EOS among preterm, low birth weight neonates, as well as further investigation into E.coli EOS resistance patterns.

Sepsis in previously healthy neonates discharged home after delivery in Soweto, South Africa

There is a paucity of data on the aetiology of neonatal sepsis in sub-Saharan Africa.To investigate the incidence, aetiology and outcomes of physician-diagnosed sepsis in hospitalised neonates who had previously been discharged home after delivery in Soweto, South Africa.A retrospective review using data abstracted from clinical and laboratory databases identified physician-diagnosed sepsis cases in neonates admitted to the general paediatric wards at Chris Hani Baragwanath Academic Hospital from January 2015 to September 2016. Neonates with physician-diagnosed sepsis were categorised into two groups based on putative pathogens recovered from blood and/or cerebrospinal fluid specimens: (i) culture-confirmed sepsis; and (ii) culture-negative sepsis.Of 1 826 neonatal admissions, 1 025 (56.2%) had physician-diagnosed sepsis: 166 (16.2%) with culture-confirmed sepsis and 859 (83.8%) with culture-negative neonatal sepsis. The commonest pathogens causing culture-confirmed neonatal sepsis were Streptococcus viridans (n=53; 26.5%), S. agalactiae (n=38; 19.0%), and Staphylococcus aureus (n=25; 12.5%). The case fatality rates for culture-confirmed sepsis and culture-negative sepsis were 10.8% (18/166) and 2.6% (22/859), respectively. The odds of death occurring during hospitalisation was 10-fold (95% confidence interval 3.7 - 26.9) higher in neonates with culture-confirmed sepsis compared with culture-negative sepsis.In our setting, physician-diagnosed sepsis represents a huge disease burden in previously healthy neonates hospitalised from home. Most sepsis cases were attributed to S. viridans, S. agalactiae and S. aureus.

Changing Trends of Antimicrobial Resistance in Neonatal Sepsis: Experience from a Tertiary Care Hospital from West Bengal, India

Introduction: Sepsis is the second leading cause of neonatal mortality in India. Emergence of highly resistant microorganisms as an aetiology of neonatal sepsis is a matter of serious concern. Aim: To study the prevailing aetiological agents in neonatal sepsis and their antimicrobial susceptibility pattern. Materials and Methods: A prospective observational study was performed in a tertiary care teaching hospital in neonatal care units in North Bengal Medical College and Hospital, West Bengal, India, over a period of two years from March 2017 to February 2019. All the neonates having clinical features suggestive of sepsis were subjected to blood culture using BacT/ALERT® PF Plus. Microbial identification and antibiotic susceptibility testing was done by VITEK-2 automated systems. Chi-square test was done using Epi info software version 7.1 and p-value <0.05 was considered significant. Results: Out of 403 neonates investigated for suspected sepsis, 156 (38.7%) were found to be culture positive. Klebsiella pneumoniae was the most common organism isolated (n=90, 57.7%) followed by Staphylococcus aureus (n=24, 15.4%) and Acinetobacter baumannii (n=10, 6.4%). Klebsiella pneumoniae showed a very high degree of resistance to ampicillin, amoxycillin- clavulenic acid (100% each), cefotaxime (93.4%), ceftazidime (92.3%), gentamycin (94.5%) and tobramycin (94.5%). High resistance of Staphylococcus aureus was seen against ampicillin (100%), cloxacillin (62.5%), amoxicillin-clavulenic acid (70.9%), and cefotaxime (79.2%). Few isolates of Klebsiella pneumonia (6.6%), Acinetobacter baumannii (60%) and Enterobacter cloacae (50%) were sensitive only to colistin and tigecycline. Conclusion: Most of the isolates showed very high degree of resistance against first line of antibiotics recommended by World Health Organisation (WHO) (ampicillin and gentamycin or amikacin) for empirical treatment of neonatal sepsis. Emergence of highly resistant organisms sensitive only to colistin and tigecycline should be considered as an eye opener. Strict adherence to sepsis prevention along with regular surveillance of organisms and their sensitivity patterns is the need of the hour to improve survival by contributing to antibiotic stewardship.

Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh.

Sepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh. This was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis. A total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04-7.23, p <0.05), premature birth (aOR 2.77, 95% CI: 1.08-7.13, p <0.05) and APGAR score <7 at five minutes (aOR 2.58, 95% CI: 1.04-6.39, p <0.05) were associated with onset of neonatal sepsis in multiple logistic regression model. All these factors were also associated with developing early-onset neonatal sepsis, while maternal UTI and male sex of neonates were associated with developing late-onset neonatal sepsis. Escherichia coli (40.7%), Staphylococcus aureus (27.5%), and Klebsiella pneumoniae (18.7%) were the commonly isolated organisms causing neonatal sepsis. All these organisms were highly resistant to common antibiotics like amoxicillin, cephalosporins, aminoglycosides and quinolones. Carbapenemase group of drugs along with amikacin, nitrofurantoin and linezolid were the most sensitive drugs. Strengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance.

Aetiology of neonatal sepsis in Nigeria, and relevance of Group b streptococcus: A systematic review.

BackgroundGroup B Streptococcus (GBS) causes invasive infections in neonates and has been implicated as a cause of prelabour rupture of membranes, preterm delivery and stillbirths. The success of phase II trials of polyvalent polysaccharide GBS vaccines indicates that these infections are potentially preventable. Nigeria is the most populous country in Africa with one of the highest birth rates, one of the highest neonatal sepsis incidence rates and one of the highest mortality rates in the world. Therefore, before the possible introduction of preventive strategies such as intrapartum antibiotic prophylaxis or GBS vaccine into Nigeria, it is vital that there is accurate data on the aetiology of neonatal sepsis and on the incidence of GBS neonatal sepsis in particular. The objective of this study was to determine the incidence and aetiology of neonatal sepsis in Nigeria with a focus on GBS sepsis and also to assess the potential impact of a GBS vaccine.MethodsA literature search was conducted on the databases of African journals online, PubMed and Google Scholar for works conducted between 1987 to 2017. Case reports, reviews, and studies not stating specific culture methods or specific bacteria isolated were excluded. Data extracted included; incidence of neonatal sepsis, method of blood culture, blood volume, sample size, bacterial agents isolated and history of antibiotic use. PRISMA guidelines were followed and modified Down’s and Black criteria used to evaluate the quality of studies.ResultsA total of 5,114 studies were reviewed for neonatal sepsis out of which 24 consisting of a total of 2,280 cases were selected for final review. Nine studies met criteria for assessment of hospital based incidence of neonatal sepsis representing 31,305 hospital births. The incidence of neonatal sepsis was 18.2/1000 livebirths with range from 7-55/1000 livebirths while the GBS incidence was 0.06/1000 livebirths with range from 0-2/1000 live births. We discovered various limitations such as identification techniques that could result in underestimation of the true incidence of GBS sepsis. Pathogens such as Klebsiella pneumoniae and Staphylococcus aureus were more commonly isolated than GBS.Implications of key findingsThe hospital based incidence of neonatal sepsis was high at 18.2/1000 live births while that due to GBS was 0.06/1000 live births. The burden of neonatal sepsis, including that attributable to GBS is substantial and could be reduced by preventive strategies such as intrapartum antibiotic prophylaxis or GBS vaccine. There is however very sparse meaningful data currently. Well planned prospective studies with larger sample sizes, more advanced isolation and identification techniques and those following up invasive disease cases for possible short and long term sequelae are needed—not only prior to possible introduction of the vaccine to determine the baseline epidemiology, but also thereafter to monitor its impact on the population. Strategies need to be developed to also reduce the morbidity and mortality attributable to other bacteria that have an incidence even greater than that of GBS.

Profile: Karachi Health and Demographic Surveillance System of Pakistan (KHDSS)

ObjectiveThe mandate of establishing this DSS is to provide a research platform for both observational and interventional studies, with focus on maternal and child health, which could influence decision-making and planning for health strategies at local, national and international levels.IntroductionThe Karachi Health and Demographic Surveillance System was set up in year 2003 by the Department of Pediatrics and Child Health of the Aga Khan University, Karachi, Pakistan, in four peri-urban low socioeconomic communities of Karachi and covers an area of 17.6 square kilometers.(Figure 1)MethodsTotal population currently under surveillance is 299,009 for which a record of births, deaths, pregnancies and migration events is maintained by two monthly household visits. At each re-enumeration, Community Health Workers move through the area using GIS-derived maps and collect the information from households and conduct verbal autopsies for stillbirths and deaths of children under the age of five and adult female. Primary Health Care centre at each site provide free care to children under 5.ResultsThe demographic characteristics for the year 2016 are summarized in Table 1. The main demographic indicators for a period of five years enable us to study the trends of population dynamics and reasons for the change in the rates of stillbirth, under 5 children mortality and maternal mortality (Table 2). Under 5 mortality rates peaked in 2013 and 2016 due to measles epidemic. Within the time period of five years, a reduction in neonatal mortality rates is observed (Table 2).For over a decade, the KHDSS has been a platform for a variety of studies. At the outset, various epidemiological studies were conducted in the area of infectious diseases of children, identifying signs and symptoms in young infant requiring urgent referral, vaccine coverage and the impact of multiple interventions. The focus was on measuring burden of relevant and common childhood illnesses. Some of these projects include: calculation of the incidence of various infectious diseases like typhoid bacteremia, pneumonia and diarrhea, evaluation of effectiveness of various treatment regimens for neonatal sepsis, assessment of the acceptance of hospitalized care, determining etiology of moderate to severe diarrhea, assessment of burden and etiology of neonatal sepsis and a multi-center cohort measuring the burden of stillbirths, neonatal and maternal deaths. (1-5)ConclusionsAll the studies aim for improvement of public health policies and informed decision making at local and national levels. We have also established a bio-repository of a well-defined maternal and newborn cohort.

Profile: Health and Demographic Surveillance System in peri-urban areas of Karachi, Pakistan

The Aga Khan University’s Health and Demographic Surveillance System (HDSS) in peri urban areas of Karachi was set up in the year 2003 in four low socioeconomic communities and covers an area of 17.6 square kilometres. Its main purpose has been to provide a platform for research projects with the focus on maternal and child health improvement, as well as educational opportunities for trainees. The total population currently under surveillance is 249,128, for which a record of births, deaths, pregnancies and migration events is maintained by two monthly household visits. Verbal autopsies for stillbirths, deaths of children under the age of five years and adult female deaths are conducted. For over a decade, the HDSS has been a platform for a variety of studies including, calculation of the incidence of various infectious diseases like typhoid bacteremia, pneumonia and diarrhea, evaluation of effectiveness of various treatment regimens for neonatal sepsis, assessment of the acceptance of hospitalized care, determination of the etiology of moderate to severe diarrhea, assessment of burden and etiology of neonatal sepsis and a multi-centre cohort study measuring the burden of stillbirths, neonatal and maternal deaths. We have also established a bio-repository of a well-defined maternal and newborn cohort. Through a well-established HDSS rooted in maternal and child health we aim to provide concrete evidence base to guide policy makers to make informed decisions at local, national and international levels.

Bacteriological profile and antibiogram of blood culture isolates done by automated culture and sensitivity method in a neonatal intensive care unit in a tertiary care hospital in Odisha, India

Background: Sepsis is one of the commonest cause of neonatal mortality. The aetiology of neonatal sepsis has variations according to the various customs and practices in the perinatal and neonatal period and geographical area. This study was designed to analyse the magnitude and aetiological characteristics of neonatal sepsis & also the antibiotic sensitivity pattern of the isolates. Methods: This prospective study was conducted in the Department of Microbiology including 250 neonates with suspected neonatal sepsis admitted to Dept. of Paediatrics & NICU, of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, during the period from Nov. 2012 - April 2014. Two ml of venous blood was taken from each neonate & cultured by automated BacT/Alert & VITEK2 method for rapid isolation & sensitivity test. A structured proforma was used to collect the information for the baseline characteristics like age, gender, birth weight, gestational age, mode of delivery of the neonate and age of onset of illness. Results: Amongst the total samples processed, 82(32.8%) became culture positive among which gram positive bacteria were the most predominant (65.8%). Out of all the gram positive pathogens, CoNS were the most common isolates (88.5%). Among the total culture positive pathogenic isolates (n=82), S. haemolyticus was the predominant bacteria 28 (34.1%) followed by S. epidermidis 12 (14.6%) and Esch coli . 8 (9.8%). Staph. aureus was isolated from 6 (7.3%) cases whereas candida spp. were isolated from only 8 cases (9.6%). Conclusions: Present study revealed that both gram positive and gram negative bacteria were responsible for blood stream infections and most of the strains were multidrug resistant. Among gram positive bacterial pathogens, most common were Coagulase Negative Staphylococcus (CoNS) (88.5%) followed by Staphylococcus aureus (7.3%).

A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border

BackgroundEach year an estimated four million neonates die, the majority in the first week of life. One of the major causes of death is sepsis. Proving the incidence and aetiology of neonatal sepsis is difficult, particularly in resource poor settings where the majority of the deaths occur.MethodsWe conducted a three year observational study of clinically diagnosed early onset (<7 days of age) neonatal sepsis (EONS) in infants born to mothers following antenatal care at the Shoklo Malaria Research Unit clinic in Maela camp for displaced persons on the Thailand-Myanmar border. Episodes of EONS were identified using a clinical case definition. Conventional and molecular microbiological techniques were employed in order to determine underlying aetiology.ResultsFrom April 2009 until April 2012, 187 infants had clinical signs of EONS, giving an incidence rate of 44.8 per 1000 live births (95% CI 38.7-51.5). One blood culture was positive for Escherichia coli, E. coli was detected in the cerebrospinal fluid specimen in this infant, and in an additional two infants, by PCR. Therefore, the incidence of bacteriologically proven EONS was 0.7 per 1000 live births (95% CI 0.1 – 2.1). No infants enrolled in study died as a direct result of EONS.ConclusionA low incidence of bacteriologically proven EONS was seen in this study, despite a high incidence of clinically diagnosed EONS. The use of molecular diagnostics and nonspecific markers of infection need to be studied in resource poor settings to improve the diagnosis of EONS and rationalise antibiotic use.

Epidemiology of neonatal infections: Community experience

Neonatal sepsis is one of the commonest causes of neonatal death in the developing world accounting for 30–50% of all neonatal deaths per year. The reported incidence of neonatal sepsis varies from 7.1 to 38 per thousand live births in Asia. The organisms causing neonatal sepsis in developing countries (gram-negative) are different from those seen in developed countries (gram-positive organisms). There are very few community based studies on etiology of neonatal sepsis and limited data are available from first level health facilities and home delivered babies. Antibiotic resistance in strains causing neonatal sepsis is increasingly being reported from developing countries from intensive care units as well as community. Signs of sepsis in neonates are often non-specific and high degree of suspicion is needed for early diagnosis. Most of the diagnostic tests are not available in secondary and primary level care; diagnostic approach mostly focuses on history and review of non specific signs and symptoms. This review highlights studies testing and validating clinical algorithms for diagnosis and management of sick child in the community - identifies gaps in such strategies, strategies for prevention of neonatal sepsis and future areas of research.

The bacteriology of neonatal septicaemia in Ile-Ife, Nigeria.

The incidence of septicaemia among neonates categorized as being at high risk was 55 per cent in Ile-Ife, Nigeria. Gram-positive organisms, specifically Staphylococcus aureus, were predominant (33.8 per cent) among bacteria cultured from proven cases of septicaemia. Other coagulase-negative staphylococci also contributed 21 per cent, with Staphylococcus epidermidis occurring in 5 per cent of the isolates. Listeria monocytogenes was cultured from 8.4 per cent of septic neonates. Pseudomonas aeruginosa was cultured from 3 per cent, Klebsiella pneumoniae from 14 per cent, and Escherichia coli from 7 per cent. Other Gram-negative bacilli cultured were Enterobacter aerogenes (5 per cent), Citrobacter freundii, Salmonella sp., and Proteus sp. (2 per cent each). The bacterial isolates were relatively resistant to antibiotics traditionally employed to treat cases of septicaemia. The study shows a high prevalence of neonatal bacterial sepsis at the centre and the emerging role of Listeria monocytogenes in the aetiology of neonatal sepsis. It highlights the preponderance of multiple antibiotic resistant organisms among these neonates early in life which is of epidemiological importance in the control of the infectious agents.

Bacterial translocation in the newborn rabbit: effect of age on frequency of translocation

Sepsis is a significant cause of morbidity and mortality in neonates, and in a significant number of cases no predisposing factors can be identified. We hypothesize that bacterial translocation (BT) may be the etiology of neonatal sepsis when no source is identified. Mesenteric lymph nodes (MLN), spleen (SPL), and liver (LIV) were harvested from 36 rabbit pups ranging in age from 4 to 24 days and divided into three groups based on their age: group I, 4-6 days; group II, 13-15 days; and group III, 22-24 days. Tissues from each organ were homogenized and placed in both aerobic and anaerobic environments. After 48 h the number of colony-forming units/g tissue was identified. The total percentage of positive growth was significantly higher in group ! for MLN (33%) and LIV (23%) when compared to groups II and III (<4% for both groups). Gram-negative growth (as selected by MacConkey (MC) media) was significantly higher in all tissue speci- mens from group I (MLN = 35%, SPL = 20%, LIV = 25%) compared to groups II and III (0% growth in all MC plates, P <0.01). These data support the hypothesis that sponta- neous BT occurs With significant frequency in the neonate.

Group B streptococcus amnionitis with intact membranes associated with quintuplet delivery

Chorioamnionitis is a frequent cause of premature labour and delivery, as well as of maternal and neonatal mortality. Group B streptococcus (GBS) has emerged over the past decade as a common pathogen in the etiology of neonatal sepsis. The case of chorioamnionitis reported here is unusual for three reasons: the premature labour was associated with intact membrane and amniotic fluid infected with GBS; all 5 infants were contaminated with GBS and all infants survived. Chorioamniotitis with intact membranes raises some questions regarding the antepartum use of steroids (potent anti-inflammatory agents), etc. The likelihood of chorioamnionitis in spite of cervical mucus, intact membranes, and the bacteriostatic activity of the amniotic fluid should alert the obstetrician to take special precautions, such as weekly vaginal cultures and appropriate vaginal antimicrobial treatment, in cases of imminent premature delivery.