Neonatal Meningitis Research Articles

DIC-like syndrome in a post-pre-eclampsia birth in a premature infant in a peri-COVID scenario

Abstract Objectives This article outlines an unusual presentation of a premature infant born from a pre-eclamptic mother born with a presentation resembling a disseminated intravascular coagulation syndrome. Case presentation Pregnancy-induced hypertension, also known as pre-eclampsia, and premature birth pose significant risks to neonates, making the fetus more susceptible to immunodeficiencies and coagulopathies. This article highlights a premature infant born to a pre-eclamptic mother with multiple complications. Our case involved jaundice, neonatal meningitis, thrombocytopenia, leukopenia, neutropenia, hemorrhage, apnea, gastrointestinal defects, and periventricular leukomalacia. Often these complications are seen immediately after birth; these symptoms may present after a certain amount of time lapses if the neonates if afflicted with malignancy or a viral, fungal, or bacterial infection. Here we describe the case of a premature neonate born to a preeclamptic mother that experienced these complications one day after her birth. Conclusions This is the first known case of an infant experiencing a “DIC-like” syndrome without any diagnosis of a primary hematological malignancy or infection after a certain amount of time had lapsed since her birth. As complications in premature infants as well as those from pre-eclamptic mothers are common, this case report highlights a successful model of care. We also explore the effect of a peri-COVID setting on the presentation of this patient, as similar cases have occurred post-COVID-19.

Relevance of enteroviruses in neonatal meningitis

IntroductionEnterovirus (EV) infections are the most frequent infections in the neonatal period and in many cases lead to hospital admission of the newborn (NB).The aim of this study was to determine the incidence of EV in the etiology of neonatal meningitis and to define the clinical characteristics of newborns with EV meningitis. Material and methodRetrospective observational cohort study. Including 91 NBs with meningitis and gestational age greater than 34 weeks gestational age (GA) attended in our center over a period of 16 years. ResultsThe percentage of NBs with EV meningitis was higher than that of NBs with bacterial meningitis (BM) and accounted for 78% (n=71). Half of the NBs with EV infection had a history of epidemic environment among their caregivers. Fever was present in 96% of cases as a clinical sign and, in general, sensory disturbances represented the main neurological alterations. Antibiotics (ATB) were given to 71.4% of patients with EV infection.Detection of EV in CSF samples showed a high sensitivity for the diagnosis of EV meningitis. The most frequently implicated EV types were echovirus 11, coxsackievirus B5, echovirus 18, 25 and 7. ConclusionsThe results of this series show that enterovirus infection is a common cause of neonatal meningitis. These data underline the importance of rapid EV testing of infants with suspected meningitis. This allows early diagnosis and reduces antibiotic treatment, hospitalization time and related costs.

Neonatal Meningitis Secondary to Elizabethkingia meningoseptica Infection.

Elizabethkingia meningoseptica, a rare cause of sepsis and meningitis in neonates, often associated with a wide spectrum of clinical presentation. The objective of the study was to describe the clinical characteristics and outcome of neonates, who developed meningitis secondary to Elizabethkingia meningoseptica infection at a tertiary care Neonatal unit in India. This retrospective study was conducted in the neonatal unit of a tertiary care hospital in New Delhi. The clinical data including demographic data, clinical presentation, management, and outcome data were collected and analyzed. During the study, 7 neonates with meningitis secondary to Elizabethkingia infection were identified. Majority of the neonates were preterm with a median gestational age of 31 (interquartile range: 29-33.5) weeks and a median birth weight of 1250 g (interquartile range: 1024-2065). The median age of onset of symptoms was 7 days. Lethargy (100%), apnea (85%), seizure (71%), and feeding difficulties (42%) were the common clinical presentations. Overall mortality during the period was 28.5%, and 60% of the survivor developed hydrocephalus. Isolated strains were resistant to the commonly used antibiotics (piperacillin-tazobactam, aminoglycosides, meropenem, and colistin) effective against Gram-negative organisms. The environmental screening was done but the potential source of infection could not be identified conclusively. Meningitis in neonates caused by Elizabethkingia represents a potentially life-threatening infection and is often associated with significant neurological impairment, especially in premature neonates. A prolonged duration of antibiotic therapy, longer hospital stay, and likelihood of adverse neurologic sequelae during the hospital stay and follow-up should be anticipated in such cases of meningitis.

A cross-sectional study of clinical features of bacterial meningitis among neonates presumed to have sepsis in a tertiary hospital, Dar es Salaam, Tanzania.

Identifying meningitis among neonates is usually challenging given the non-specific presentation and overlap with neonatal sepsis. This study was aimed at determining the pertinent clinical features that would suggest bacterial meningitis among infants with signs of possible serious bacterial infection and their outcomes. This hospital-based cross-sectional study was conducted among neonates presenting with clinical features of sepsis admitted at Muhimbili National Hospital (MNH) between May and December 2015. Detailed clinical features, blood cultures, and cerebrospinal fluid were obtained. The specimens were tested at the Central Pathology Laboratory at MNH. Short-term clinical outcome was also determined for recruited participants. One hundred and twenty-six neonates met the inclusion criteria and were recruited, males were 67 (53.2%) and the mean age of participants was 10.4 ± 7.9 days. Features of meningitis were noted among 19% (24/126) and very low birth weight neonates were observed to have a statistically higher prevalence of meningitis (p=0.038). Bacterial isolates from cerebrospinal fluid (CSF) culture were Klebsiella spp and E. coli, while predominant isolates from blood culture were Klebsiella spp (35%) and E. coli (20.6%). There was high resistance to ampicillin (91.2%), cloxacillin (94.1%), gentamycin (50%), and ceftriaxone (50%). A high mortality of 24.9% was noted. Neonatal meningitis is common among neonates with sepsis, and bacterial isolates were resistant to routinely used antibiotics. High mortality attributed to meningitis was noted at Muhimbili National Hospital.

The Potential ofgrxBGene for Detection ofC. sakazakiiin Infant Formula Milk Using Real-Time Polymerase Chain Reaction

Cronobacter sakazakiiis one of the bacteria that causes food poisoning that contaminates infant formula. This pathogen causes necrotizing enterocolitis, sepsis, and meningitis in infants or neonates with reported case fatality rates ranging from 40% to 80%. Therefore, it is necessary to develop fast and accurate detection ofC. sakazakiiin infant formula milk. This research aims to develop a method for detectingC. sakazakiibacteria using real-time PCR with high sensitivity, specificity, and accuracy. A rapid detection method using real-time PCR with the target genegrxBsuccessfully detects the presence of C. sakazakii DNA in artificially contaminated formula milk. The results of the real-time PCR test showed thatC. sakazakiiDNA with a concentration of 53 ng/µL could be amplified by thegrxBgene primer pair with a Ct value of 12 and a Tm value of 85.8ºC. The specificity test showed that thegrxBprimer could differentiate between target and some non-target bacteria. The sensitivity test showed the ability of thegrxBprimer to detect the smallest concentration of 3,392 pg/µL with a Ct of 24,06. Based on the results obtained, it can be concluded that thegrxBprimer has the potential to be used as rapid detection method forC. sakazakiibacteria in infant formula using real-time PCR.

An outbreak of nosocomial infection of neonatal aseptic meningitis caused by echovirus 18.

We describe an outbreak of echovirus 18 infection involving 10 patients in our neonatal intensive care unit (an attack rate of 33%). The mean age at the onset of illness was 26.8 days. Eighty percent were preterm infants. All were discharged home without sequelae. There were no differences in gestation age, birth weight, delivery mode, use of antibiotics, and parenteral nutrition between the enterovirus (EV) group and non-EV group, but the rate of breastfeeding was significantly higher in the EV group. Separation care and reinforcement of hand-washing seemed to be effective in preventing further spread of the virus. Visiting policy, hygiene practice, and handling of expressed breastmilk should be reinforced.

Risk Factors for Hearing Loss in High-Risk Neonates at a Tertiary Care Centre in Central India: A Prospective Observational Study

Introduction: Hearing impairment and deafness are global issues that affect 5% of the world’s population, with nearly 34 million children requiring rehabilitation to address their hearing loss (HL). An approximately 10-20 fold higher incidence of audiological risk factors has been noted in Neonatal Intensive Care Units (NICUs), which translates that 2-5% of all newborns in NICUs may be affected. Early diagnosis of HL and intervention can be advantageous from the timely fitting of hearing aids or cochlear implants. Aim: The aim of this study was to evaluate the risk factors for HL in NICUs and Special Neonatal Care Units (SNCUs) at a tertiary care hospital in Central India. Materials and Methods: This prospective, observational, single-centre study was conducted from October 2019 to September 2021 in the Department of Paediatrics at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. A total of 319 neonates at high risk for HL, discharged from NICUs and SNCUs, were included in the study. The association between risk factors like prematurity, low birth weight (LBW), Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex (TORCH) infections, neonatal asphyxia, neonatal sepsis, meningitis, exchange transfusion, assisted ventilation, and HL were studied. The chi-square test was used to assess the association between SNHL and risk factors. Results: The incidence of Sensorineural Hearing Loss (SNHL) was 3.76%. Neonatal asphyxia (p-value <0.01), exchange transfusion (p-value <0.001), TORCH infections (p-value < 0.001), meningitis (p-value <0.001), and assisted ventilation (p-value <0.001) were found to be significant risk factors associated with SNHL. Conclusion: Based on the assessment of risk factors, it was concluded that neonates should undergo hearing screening tests within the first month of life, and a diagnosis should be made by three months of age. This allows specialists to initiate treatment and intervention by six months of age, helping children with impaired hearing avoid the harmful consequences of semantic deprivation.

Microbial signatures of neonatal bacterial meningitis from multiple body sites.

As a common central nervous system infection in newborns, neonatal bacterial meningitis (NBM) can seriously affect their health and growth. However, although metagenomic approaches are being applied in clinical diagnostic practice, there are some limitations for whole metagenome sequencing and amplicon sequencing in handling low microbial biomass samples. Through a newly developed ultra-sensitive metagenomic sequencing method named 2bRAD-M, we investigated the microbial signatures of central nervous system infections in neonates admitted to the neonatal intensive care unit. Particularly, we recruited a total of 23 neonates suspected of having NBM and collected their blood, cerebrospinal fluid, and skin samples for 2bRAD-M sequencing. Then we developed a novel decontamination method (Reads Level Decontamination, RLD) for 2bRAD-M by which we efficiently denoised the sequencing data and found some potential biomarkers that have significantly different relative abundance between 12 patients that were diagnosed as NBM and 11 Non-NBM based on their cerebrospinal fluid (CSF) examination results. Specifically, we discovered 11 and 8 potential biomarkers for NBM in blood and CSF separately and further identified 16 and 35 microbial species that highly correlated with the physiological indicators in blood and CSF. Our study not only provide microbiological evidence to aid in the diagnosis of NBM but also demonstrated the application of an ultra-sensitive metagenomic sequencing method in pathogenesis study.

Elizabethkingia meningoseptica: A case report of an emerging and rare pathogen of neonatal meningitis isolated from a tertiary care centre

Abstract Elizabethkingia meningosepticum is ubiquitous in nature, though not a normal human flora but it is an emerging pathogen amongst immunocompromised patients. E. meningosepticum can cause a variety of infections and septicaemia and meningitis have been reported amongst immunocompromised. It is difficult to treat with a high mortality rate. This is likely due to its resistance to commonly used antibiotics for Gram-negative infections. In this report, we present a case of a neonate who was admitted for perinatal hypoxia to the neonatal intensive care unit whose blood and cerebrospinal fluid culture sample grew E. meningosepticum. The patient was initially treated with empiric antibiotics for Gram-negative infections and later linezolid. Considering the organism’s unusual susceptibility, profile close surveillance and rapid identification are needed to assist in appropriate and effective treatment.

Thermal tolerance of Cronobacter sakazakii and Cronobacter pulveris in reconstituted infant milk formula

Cronobacter sspecies are the most significant foodborne pathogen in infant milk formula (IMF). These pathogens have been incriminated in severe forms of neonatal meningitis, sepsis, and necrotizing enterocolitis with a high mortality rate. This study was performed to elucidate the effect of heat stress on Cronobacter spp. (C. sakazakii and C. pulveris) in reconstituted IMF (RIMF). The reconstituted formula was inoculated with five C. sakazakii isolates and four C. pulveris isolates separately. The nine isolates of Cronobacter spp. were heated in RIMF at 48°C, 52°C, 56°C, 60°C, 64°C, and 66°C. The D- and z-values were determined by using linear regression analysis. The D-values of all isolates of C. sakazakii (CS1, CS3, CS4, CS5, and CS6) at 48°C, 52°C, 56°C, 60°C, 64°C, and 66°C were in the ranges 7.29-23.47, 2.77-15.50, 0.62-1.04, 0.62-1.02, 0.62-1.00, 0.62-1.00 minutes, respectively; while, the z-values extended from 2.50°C to 4.28°C. The D- values of C. pulveris isolates (CP1, CP2, CP3, CP4) were in the ranges 7.60-22.32, 1.42-8.45, 0.62-1.08, 0.62-0.78, 0.62-0.78, 0.62-0.79 minutes at 48°C, 52°C, 56°C, 60°C, 64°C, 66°C, respectively and the calculated z-values ranged from 3.33°C to 4.89°C. This study may contribute to improving the understanding of the behavior of C. sakazakii and C. pulveris isolates in RIMF at various heat stress temperatures and may participate in the effective control of these pathogens in infant food production.

A bioorthogonal chemistry approach to detect the K1 polysialic acid capsule in Escherichia coli.

Most Escherichia coli strains associated with neonatal meningitis express the K1 capsule, a sialic acid polysaccharide that is directly related to their pathogenicity. Metabolic oligosaccharide engineering (MOE) has mostly been developed in eukaryotes, but has also been successfully applied to the study of several oligosaccharides or polysaccharides constitutive of the bacterial cell wall. However, bacterial capsules are seldom targeted despite their important role as virulence factors, and the K1 polysialic acid (PSA) antigen that shields bacteria from the immune system still remains untackled. Herein, we report a fluorescence microplate assay that allows the fast and facile detection of K1 capsules with an approach that combines MOE and bioorthogonal chemistry. We exploit the incorporation of synthetic analogues of N-acetylmannosamine or N-acetylneuraminic acid, metabolic precursors of PSA, and copper-catalysed azide-alkyne cycloaddition (CuAAC) as the click chemistry reaction to specifically label the modified K1 antigen with a fluorophore. The method was optimized, validated by capsule purification and fluorescence microscopy, and applied to the detection of whole encapsulated bacteria in a miniaturized assay. We observe that analogues of ManNAc are readily incorporated into the capsule while those of Neu5Ac are less efficiently metabolized, which provides useful information regarding the capsule biosynthetic pathways and the promiscuity of the enzymes involved. Moreover, this microplate assay is transferable to screening approaches and may provide a platform to identify novel capsule-targeted antibiotics that would circumvent resistance issues.

Comparative genome analysis of Streptococcus strains to identify virulent genes causing neonatal meningitis

To determine Streptococcus agalactiae genes responsible for causing neonatal meningitis. Streptococcus agalactiae strain 2603V/R is causative agent of neonatal meningitis, maternal infection and sepsis in young children. World health organisation reported high burden of new born death caused by this bacterium. Streptococcus agalactiae colonizing epithelial cells of vagina and endothelial cells have high resistance to available antibiotic drugs which makes it essential to determine new drug targets. To compare the genome of selected strain with the non-pathogenic strains of streptococcus and identify the virulent and antibiotic resistant genes for adaptation in host environment. The whole genome of human pathogen Streptococcus agalactiae strain 2603V/R was analysed and compared with Streptococcus dysgalactiae strains using visualization and annotation tools. Genomic islands, mobile genetic elements, virulent and resistant genes were studied. Genetically pathogenic strain is most similar to Streptococcus dysgalactiae subsp. equisimilis strain NCTC 7136. Comparative analysis revealed the importance of capsular polysaccharides and surface proteins responsible for avoiding immune system attachment to host epithelial cells and virulent behaviour. High number of genes coding for antibiotics resistance may provide a competitive advantage for survival of pathogenic Streptococcus agalactiae strain 2603V/R in its niche. The comparative analysis of pathogenic strain Streptococcus agalactiae with non-pathogenic strains of Streptococcus dysgalactiae provided new insights in pathogenicity that could aid in recognization for new regions and genes for development of new drug development strategies considering presence of high number of resistance genes.

Meningitis Among Neonates with Suspected Sepsis Presenting to Pediatric Emergency.

We aimed to assess the risk factors, clinical features and microbial profiles of meningitis in neonates with suspected sepsis referred to a pediatric emergency. Over 13 months, 191 neonates were enrolled, of whom 64 (33.5%) had meningitis. There were no significant differences in risk factors or clinical features between infants with and without meningitis. Ninety-three neonates (49%) had culture-positive sepsis (109 isolates). Candida spp. (n = 29), coagulase-negative staphylococci (n = 28) and Klebsiella pneumoniae (n = 23) were the most common pathogens. Forty-one (53%) bacteria were multidrug resistant.

Bacterial and prognostic profile of nosocomial meningitis in newborns

Introduction: Nosocomial neonatal meningitis is particularly dreadful because it occurs in patients of immature immunity and a developing brain. It is always a challenge for the clinician due to its clinical polymorphism making the diagnosis often difficult Aim: To study the epidemiological, clinical, bacteriological, therapeutic and evolutionary aspects of neonatal nosocomial bacterial meningitis. Results: Through our series, we reported fourteen cases of nosocomial meningitis, ie 43% of meningitis recorded over the study period. A male predominance was observed in 57.1%. The newborns were preterm in 28% of cases and had low birth weight in 42% of cases. The germ isolated was Klebsiella pneumoniae in 28.4% of cases. The blood culture was positive in 64% of cases. The same germ was isolated in both blood and the cerebrospinal fluid in 42% of cases. The complications found were: ventriculitis (28.5%), triventricular and tetraventricular hydrocephalus (14.2%) and multiple cerebral abscesses (14.2%). The mortality rate recorded in our series was 28.5%. Conclusion: Nosocomial meningitis is a serious or even fatal condition requiring early diagnosis and adequate antimacrobial therapy. Prevention remains the best strategy for the battle against this infection

Bovine Escherichia coli Mastitis and Effects on Milk Microbiota

Escherichia coli is a microorganism that is found in the normal intestinal microbiota of humans and warm-blooded animals, causing intestinal or extra-intestinal infections. Many pathogenic E. coli strains can cause diarrhea, septicemia, neonatal meningitis, mastitis, urogenital system infections and various intra-abdominal, lung, soft tissue and skin infections in pets. Determining the genotypic and phenotypic characteristics of Escherichia coli strains isolated from animals is very important for the prevention of infections caused by E. coli. In recent years, a new animal pathotype mammary pathogenic E. coli (MPEC), which causes mammary gland infections in animals has been included in the extraintestinal pathogenic E. coli group. The fact that approximately %25-%35 of the use of antimicrobials in the treatment of Gram-negative agents is unsuccessful indicates that the use of correct diagnostic tools should take place in routine before etiological diagnosis. Profiles in bovine milk with mastitis suggest that clinical mastitis is associated with dysbacteriosis and that the microbial community in an intact mammary gland helps prevent intramammary infection. In this review, the change in bacterial diversity of milk microbiota due to antimicrobial use in E. coli-induced mastitis cases is discussed together with current studies.

Lpp of Escherichia coli K1 inhibits host ROS production to counteract neutrophil-mediated elimination

Escherichia coli (E. coli) is the most common Gram-negative bacterial organism causing neonatal meningitis. The pathogenesis of E. coli meningitis, especially how E. coli escape the host immune defenses, remains to be clarified. Here we show that deletion of bacterial Lpp encoding lipoprotein significantly reduces the pathogenicity of E. coli K1 to induce high-degree of bacteremia necessary for meningitis. The Lpp-deleted E. coli K1 is found to be susceptible to the intracellular bactericidal activity of neutrophils, without affecting the release of neutrophil extracellular traps. The production of reactive oxygen species (ROS), representing the primary antimicrobial mechanism in neutrophils, is significantly increased in response to Lpp-deleted E. coli. We find this enhanced ROS response is associated with the membrane translocation of NADPH oxidase p47phox and p67phox in neutrophils. Then we constructed p47phox knockout mice and we found the incidence of bacteremia and meningitis in neonatal mice induced by Lpp-deleted E. coli is significantly recovered by p47phox knockout. Proteomic profile analysis show that Lpp deficiency induces upregulation of flagellar protein FliC in E. coli. We further demonstrate that FliC is required for the ROS induction in neutrophils by Lpp-deleted E. coli. Taken together, these data uncover the novel role of Lpp in facilitating intracellular survival of E. coli K1 within neutrophils. It can be inferred that Lpp of E. coli K1 is able to suppress FliC expression to restrain the activation of NADPH oxidase in neutrophils resulting in diminished bactericidal activity, thus protecting E. coli K1 from the elimination by neutrophils.

RyhB in Avian Pathogenic Escherichia coli Regulates the Expression of Virulence-Related Genes and Contributes to Meningitis Development in a Mouse Model

Avian pathogenic Escherichia coli (APEC) is an important member of extraintestinal pathogenic Escherichia coli (ExPEC). It shares similar pathogenic strategies with neonatal meningitis E. coli (NMEC) and may threaten human health due to its potential zoonosis. RyhB is a small non-coding RNA that regulates iron homeostasis in E. coli. However, it is unclear whether RyhB regulates meningitis occurrence. To investigate the function of RyhB in the development of meningitis, we constructed the deletion mutant APEC XM∆ryhB and the complemented mutant APEC XM∆ryhB/pryhB, established a mouse meningitis model and evaluated the role of RyhB in virulence of APEC. The results showed that the deletion of ryhB decreased biofilm formation, adhesion to the brain microvascular endothelial cell line bEnd.3 and serum resistance. RNA-seq data showed that the expression of multiple virulence-related genes changed in the ryhB deletion mutant in the presence of duck serum. Deletion of ryhB reduced the clinical symptoms of mice, such as opisthotonus, diarrhea and neurological signs, when challenged with APEC. Compared with the mice infected with the wild-type APEC, fewer histopathological lesions were observed in the brain of mice infected with the ryhB deletion mutant APEC XM∆ryhB. The bacterial loads in the tissues and the relative expression of cytokines (IL-1β, IL-6, and TNF-α) in the brain significantly decreased when challenged with the APEC XM∆ryhB. The expressions of tight junction proteins (claudin-5, occludin and ZO-1) were not reduced in the brain of mice infected with APEC XM∆ryhB; that is, the blood-brain barrier permeability of mice was not significantly damaged. In conclusion, RyhB contributes to the pathogenicity of APEC XM in the meningitis-causing process by promoting biofilm formation, adhesion to endothelial cells, serum resistance and virulence-related genes expression.

Maternal Origins of Neonatal Infections: What Do Obstetrician–Gynecologist Should/Could Do?

Neonatal infections are responsible for 20% of neonatal deaths yearly. In this review, we focused on the origins of the commoner neonatal infections, and we define the role of obstetricians. Regarding group B Streptococcus, a key measure for the prevention of neonatal infection is the vaginal-rectal culture screening at term pregnancy. Intravenous penicillin is the first-line prophylaxis at the start of labor, with intravenous ampicillin as an alternative. First-generation cephalosporins or clindamycin are recommended in case of penicillin allergy. Concerning urinary tract infections (UTIs), guidelines recommend complete urinalysis and urine culture in the first trimester of pregnancy for the screening of asymptomatic bacteriuria. For lower UTIs, guidelines recommend nitrofurantoin as first-choice antibiotic. Amoxicillin or cefalexin are second-line antibiotics. For upper UTIs, guidelines recommend cephalexin per os as first line. Candida spp. colonization affects 20% of pregnant women; however, congenital fetal candidosis and Candida amnionitis are rare. First-line treatment in case of symptomatic vaginitis during pregnancy or asymptomatic colonization during the third trimester is vaginal clotrimazole. Fluconazole is not approved in pregnancy, especially during the first trimester. Genital mycoplasmas colonization during pregnancy is usually asymptomatic and associated with bacterial vaginosis. Colonization is related to neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pneumonia, chorioamnionitis, and sepsis. Macrolides are the first-line treatment along with lactobacillus supplementation. In cases of preterm premature rupture of membranes or preterm labor, ceftriaxone, clarithromycin, and metronidazole are required to prevent intra-amniotic infection. Intra-amniotic infection affects 1 to 5% of deliveries at term and one-third of preterm ones and is associated with perinatal death, early-onset neonatal sepsis, RDS, BPD, pneumonia, meningitis, and prematurity-related diseases. Guidelines recommend a combination of ampicillin and gentamicin, and in case of caesarean section, an additional dose of clindamycin or metronidazole is required. In conclusion, obstetricians should be aware that the treatment of maternal infection during pregnancy can prevent potentially lethal infections in the newborn. KEY POINTS: · Part of neonatal infections starts from maternal infections that must be treated during pregnancy.. · Streptococcus group B and asymptomatic bacteriuria should be investigated in pregnancy and treated.. · Mycoplasma and ureaplasma vaginal colonization during pregnancy is related to negative neonatal outcomes..

Neonatal bacterial meningitis: hearing screening and audiological monitoring outcomes

Objective This study reviewed the outcomes of universal newborn hearing screening (UNHS) and ongoing hearing monitoring in children following recovery from neonatal bacterial meningitis to determine (a) whether screening may be a suitable alternative to diagnostic audiology for detecting permanent childhood hearing loss (PCHL) and (b) whether infants who pass UNHS should be monitored throughout childhood. Design Retrospective analysis of a UNHS database. Study sample Data were extracted from the state-wide UNHS database for all children born in Queensland Australia between 1 September 2004 and 30 June 2020 with the risk factor of bacterial meningitis (in isolation or in combination with other risk factors) identified at the time of the UNHS. This cohort included 231 children. Results Results showed that all post-meningitic infants diagnosed with PCHL had a refer result on the UNHS or were medically excluded from screening. Additionally, no cases of PCHL were identified through the targeted surveillance program following a pass result on UNHS. Conclusions UNHS may be sufficient to detect PCHL in post-meningitic neonates and routine audiological monitoring may not be required for children who pass the screen.

INFECTION DUE TO DRUG RESISTANT ELIZABETHKINGIA MENINGOSEPTICA IN A TERTIARY CARE HOSPITAL IN INDIA

Elizabethkingia meningoseptica is a Gram-negative nonfermentative bacilli found ubiquitous in soil, plants, water etc.. It is colonized in different medical devices like intravascular catheters, implanted devices etc. causing life-threatening infections like bacteremia, pneumonia, neonatal meningitis, sepsis, endophthalmitis, soft-tissue infections etc. primarily in the patients of intensive care units (ICUs). This study highlights the emergence of E.meningoseptica infection in the healthcare setting and its unusual drug resistance pattern making it more challenging for the therapeutic management. The maximum susceptibility (80%) was observed against cefoperazone-sulbactum, piperacillin-tazobactum and levooxacin followed by meropenem (60%). Susceptibility against imipenem, ciprooxacin, cotrimoxazole was observed approximately 40%.