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Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.

Publication ,  Journal Article
Stoll, BJ; Hansen, NI; Sánchez, PJ; Faix, RG; Poindexter, BB; Van Meurs, KP; Bizzarro, MJ; Goldberg, RN; Frantz, ID; Hale, EC; Shankaran, S ...
Published in: Pediatrics
May 2011

BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was defined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006-2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

May 2011

Volume

127

Issue

5

Start / End Page

817 / 826

Location

United States

Related Subject Headings

  • United States
  • Survival Analysis
  • Streptococcus agalactiae
  • Streptococcal Infections
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Primary Prevention
  • Pediatrics
  • Neonatal Screening
 

Citation

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Stoll, B. J., Hansen, N. I., Sánchez, P. J., Faix, R. G., Poindexter, B. B., Van Meurs, K. P., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, . (2011). Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics, 127(5), 817–826. https://doi.org/10.1542/peds.2010-2217
Stoll, Barbara J., Nellie I. Hansen, Pablo J. Sánchez, Roger G. Faix, Brenda B. Poindexter, Krisa P. Van Meurs, Matthew J. Bizzarro, et al. “Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.Pediatrics 127, no. 5 (May 2011): 817–26. https://doi.org/10.1542/peds.2010-2217.
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011 May;127(5):817–26.
Stoll, Barbara J., et al. “Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.Pediatrics, vol. 127, no. 5, May 2011, pp. 817–26. Pubmed, doi:10.1542/peds.2010-2217.
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, Bizzarro MJ, Goldberg RN, Frantz ID, Hale EC, Shankaran S, Kennedy K, Carlo WA, Watterberg KL, Bell EF, Walsh MC, Schibler K, Laptook AR, Shane AL, Schrag SJ, Das A, Higgins RD, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011 May;127(5):817–826.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

May 2011

Volume

127

Issue

5

Start / End Page

817 / 826

Location

United States

Related Subject Headings

  • United States
  • Survival Analysis
  • Streptococcus agalactiae
  • Streptococcal Infections
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Primary Prevention
  • Pediatrics
  • Neonatal Screening