No abstract

Within a three-month period 13 cases of listeriosis in the newborn were seen at the National Women's Hospital, Auckland. Eleven presented in the first 24 hours of life, the most common feature being respiratory difficulty in low birth weight infants. Meconium-stained liquor was noted in nine cases. The constant finding in all cases was an aspiration pneumonia which appeared to be of intrauterine origin from an infected amniotic cavity. There was also evidence of septicaemia in nine cases, and two infants survived meningitis which developed at 1 week. Maternal symptoms were mild and variable, and in only one case were they proved to be due to listerial infection. The mothers came from different suburbs of Auckland and no common source of infection was found.

Since 1970 there has been an increase in isolations of Group B P-haemolytic streptococci from infants and mothers at the National Women's Hospital and the organism has become the major cause of fatal perinatal infection. Forty-three of 60 stillborn and liveborn infants with postmortem isolations of Croup B streptococci had pneumonia and of these a minority also had meningitis and/or septicaemia. Amnionitis was found in 15 of 20 placentae examined from these patients and an ascending infection from the maternal genital tract, often through intact membranes, was considered likely in the majority. However, a review of the prenatal histories of 33 infants showed that only a minority had premonitory features such as prolonged rupture of membranes, prolonged labour or maternal fever. Thirteen of 26 liveborn infants had a birth weight less than 2500 g. The majority presented within one hour of birth with respiratory distress or apnoea and died within 48 hours of birth. Early diagnosis of Group B infection is possible if bacteriological and radiological evidence is sought in infants of low birth weight, with low Apgar scores and with early onset of respiratory distress syndrome or apnoea in addition to those having the more usual indications of intrauterine infection. Group B streptococci were carried vaginally in 9 per cent of women attending an antenatal clinic and this high carrier rate is considered to preclude prophylactic treatment. A RECENT increase in perinatal infections by Group B (3-haemolytic streptococci (Group B streptococci) has been reported from several centres in the United States (Eickhoff et al, 1964; Baker and Barrett, 1973; Franciosi et al, 1973; Hey et al, 1973; Quirante et al, 1974; Present appointments:

SUMMARY An increased incidence of E. coli sepsis has been observed in neonates given intramuscular iron-dextran for prevention of iron deficiency. Mechanisms for this apparent effect on susceptibility to infection were investigated by comparing phagocytic and antibacterial functions in paired samples of venous blood from 7 infants, median age 5 days, before and after iron-dextran. Post-treatment sera had increased inhibitory effects on leucocyte chemotaxis and markedly reduced bacteriostatic effects against E. coli. The clinical relevance of the effects on chemotaxis is uncertain. The reduction in serum bacteriostasis is similar to that observed in other forms of hyperferraemia not associated with saturation of transferrin, and is a likely cause of the increased susceptibility to infection in vivo. We consider that prophylactic treatment with parenteral iron-dextran is contraindicated in early infancy.The prevention of iron deficiency in 'high risk' infant populations by giving iron-dextran intramuscularly to babies in maternity hospitals was advocated in New Zealand after favourable results were reported from pilot studies (Tonkin, 1970;Cantwell, 1972 Cellular.

These results highlight the potential importance of literacy, and religious or cultural influences on the success of the Expanded Programme of Immunization, and will have important implications for areas with similar cultural demographics.