Neonatal Group B Streptococcal Disease in a Neonatal Intensive Care Unit: A Twelve-Year Study

Abstract

Introduction: Group B Streptococcus (GBS) is a gram-positive coccus, that frequently colonizes the human genital and gastrointestinal tract, and is the most common cause of invasive infections in neonates. The high clinical suspicion and early treatment are essential to prevent devastating sequelae and improve the prognosis of these patients. Materials and Methods: A retrospective descriptive study made with children younger than 3 months of age, admitted to a neonatal intensive care unit of a level II hospital, from January 1, 2010 to December 31, 2021, with early (EOI) or late-onset (LOI) neonatal GBS infection. Reviewed obstetric history, risk factors, intrapartum chemoprophylaxis (IPA), clinical manifestations, antibiotic therapy, supportive care, recurrent infection, morbidities and deaths. Results: There were 6 cases registered during 12-year period with GBS infection, 3(50%) had EOI, 3(50%) had LOI and 1 case with recurrent infection (more 2 episodes). Most cases were prematures (4/6; 67%)with average gestational age of 29weeks. Eight GBS infections were documented. In EOI, prematurity and prolonged rupture of membranes without chemoprophylaxis were identified as risk factors. The most common clinical diagnosis was meningitis (62,5%, 5/8) and sepsis/bacteriemia without a focus (37,5%, 3/8). The most used empirical therapy was ampicillin, gentamicin and cefotaxime (50%, 4/8) and the most frequent definitive therapy was Penicillin G. 4 patients needed ventilatory support and 1 needed shock and seizures treatment. In one case hydrocephalus and delayed psychomotor development (DPD) were reported and in another case DPD and eyelid ptosis were also reported. 1 death occurred. Conclusion: In our study, maternal colonization wasn’t a risk factor for EIO, because the 4 mothers who performed GBS culture (2 mothers of term newborns and 2 mothers of preterms, one with invasive disease and other with recurrent infection) were negative. We obtained a higher percentage of meningitis than previously described (62.5% vs 5-10%), probably because most patients were premature and immunosuppressed.