Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues

Barbara J Stoll; Nellie I Hansen; Roger G Faix; Brenda B Poindexter; Krisa P Van Meurs; Matthew J Bizzarro; Ronald N Goldberg; Ivan D Frantz; Ellen C Hale; Seetha Shankaran; Kathleen Kennedy; Waldemar A Carlo; Kristi L Watterberg; Edward F Bell; Michele C Walsh; Kurt Schibler; Abbot R Laptook; Andi L Shane; Stephanie J Schrag; Abhik Das; Rosemary D Higgins; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1542/peds.2010-2217

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Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues

Journal article

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Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues

Barbara J Stoll, Nellie I Hansen, Roger G Faix, Brenda B Poindexter, Krisa P Van Meurs, Matthew J Bizzarro, Ronald N Goldberg, Ivan D Frantz, Ellen C Hale, Seetha Shankaran, …

Pediatrics (Evanston), Vol.127(5), pp.817-826

05/2011

DOI: 10.1542/peds.2010-2217

PMCID: PMC3081183

PMID: 21518717

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Abstract

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.

group B streptococcal disease

Escherichia coli infection

neonatal sepsis

Details

Title: Subtitle: Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues
Creators: Barbara J Stoll - Emory University School of Medicine, Department of Pediatrics, and Children's Healthcare of Atlanta, Atlanta, Georgia
Nellie I Hansen - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
Roger G Faix - Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, Utah
Brenda B Poindexter - Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
Krisa P Van Meurs - Division of Neonatology, Stanford University Medical Center, Palo Alto, California
Matthew J Bizzarro - Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
Ronald N Goldberg - Department of Pediatrics, Duke University, Durham, North Carolina
Ivan D Frantz - Department of Pediatrics, Tufts Medical Center, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
Ellen C Hale - Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
Seetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, Michigan
Kathleen Kennedy - Department of Pediatrics, University of Texas Medical School at Houston, Texas
Waldemar A Carlo - Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama
Kristi L Watterberg - Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City, Iowa
Michele C Walsh - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
Kurt Schibler - Department of Pediatrics, University of Cincinnati, Ohio
Abbot R Laptook - Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
Andi L Shane - Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
Stephanie J Schrag - Centers for Disease Control and Prevention, Atlanta, Georgia
Abhik Das - Statistics and Epidemiology Unit, RTI International, Rockville, Maryland
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.127(5), pp.817-826
DOI: 10.1542/peds.2010-2217
PMID: 21518717
PMCID: PMC3081183
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Publisher: American Academy of Pediatrics
Language: English
Date published: 05/2011
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093322202771

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