A Retrospective Review of Neonatal Sepsis among GBS-Colonized Women Undergoing Planned Cesarean Section after Labor Onset or Rupture of Membranes

Background. Sepsis is a leading cause of mortality and morbidity in neonates, with group B streptococcus (GBS) remaining the most frequent pathogen isolated from term infants. Surveillance data showed that the majority of cases of early-onset GBS disease were neonates born to women who either received no or suboptimal intrapartum antibiotic prophylaxis with a notable portion of those women having a missed opportunity to receive ≥4 hours of chemoprophylaxis. Women planning delivery by cesarean section who present in labor or rupture of membranes prior to their scheduled surgery are unlikely to receive optimal GBS chemoprophylaxis and thus their neonates are at risk of having sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads was extracted from the Consortium on Safe Labor dataset. Women who had an unlabored cesarean section at ≥37+0 week gestation were selected and divided into four groups based on GBS status and timing of cesarean section with respect to onset of labor or rupture of membranes. The rate of neonatal sepsis and the patterns of intrapartum antibiotic chemoprophylaxis were determined. Results. The sepsis rate (4.5%) among neonates of GBS-colonized women having their unlabored cesarean section after onset of labor or rupture of membranes was significantly higher than that in any other group in this study. In this group, 9.4% of women received chemoprophylaxis for ≥4 hours, while 31% had a missed opportunity to receive ≥4 hours of chemoprophylaxis. Conclusion. This study suggests that neonates of GBS-colonized women having a planned cesarean section after onset of labor or rupture of membranes are at increased risk of having a sepsis diagnosis. This finding suggest the need for additional studies to assess the risk of sepsis among neonates of women in this group.

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Aetiologies and risk factors for neonatal sepsis and pneumonia mortality among Alaskan infants

Epidemiology and Infection ◽

10.1017/s0950268805004449 ◽

2005 ◽

Vol 133 (5) ◽

pp. 877-881 ◽

Cited By ~ 6

Author(s):

B. D. GESSNER ◽

L. CASTRODALE ◽

M. SORIANO-GABARRO

Keyword(s):

Risk Factors ◽

Neonatal Sepsis ◽

Rate Ratio ◽

Neonatal Period ◽

Group B Streptococcus ◽

Sepsis Mortality ◽

Term Infants ◽

Gram Positive Bacteria ◽

Increased Risk ◽

Group B

We evaluated all fatal neonatal sepsis and pneumonia cases occurring in Alaska during 1992–2000. Risk factors were evaluated using a database of all births occurring during the study period. Of 32 cases, group B streptococcus (GBS) was isolated from 21% (all <7 days of age), Candida spp. from 19% (all >7 days of age), non-GBS Gram-positive bacteria from 50% (53% <7 days of age), and Gram-negative infections from 38% (58% <7 days of age). Infants born at <37 weeks gestation accounted for 72% of cases and had an increased risk of GBS [rate ratio (RR) 9·1, 95% confidence interval (CI) 2·0–41] and non-GBS (RR 40, 95% CI 16–101) disease. Neonatal sepsis mortality has become an outcome concentrated among pre-term infants. Aetiologies include GBS during the early neonatal period, Candida spp. during the late neonatal period, and other bacteria during both periods.

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Fatal, Fulminant and Invasive Non-Typeable Haemophilus influenzae Infection in a Preterm Infant: A Re-Emerging Cause of Neonatal Sepsis

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5010030 ◽

2020 ◽

Vol 5 (1) ◽

pp. 30 ◽

Cited By ~ 2

Author(s):

Sudipta Roy Chowdhury ◽

Srabani Bharadwaj ◽

Suresh Chandran

Keyword(s):

Haemophilus Influenzae ◽

Preterm Infant ◽

Neonatal Sepsis ◽

Group B Streptococcus ◽

Invasive Disease ◽

Preventative Measures ◽

Increased Risk ◽

Extremely Preterm ◽

Serotype B ◽

Group B

Early-onset neonatal sepsis (EOS) is a major cause of neonatal death and long-term neurodevelopmental disabilities among survivors. The common pathogens causing EOS are group B streptococcus (GBS) and Escherichia coli. Haemophilus influenzae (H. influenzae) is a Gram-negative coccobacillus that can cause severe invasive disease and can be divided into either typeable or non-typeable strains. H. influenzae serotype b (Hib) is the most virulent and the major cause of bacterial meningitis in young children prior to routine immunization against Hib. Hib infection rates have dramatically reduced since then. However, a number of studies have reported an increasing incidence of non-typeable H. influenzae (NTHi) sepsis in neonates worldwide and concluded that pregnant women may have an increased risk to invasive NTHi disease with poor pregnancy outcomes. We present a case of fulminant neonatal sepsis caused by NTHi in an extremely preterm infant and discuss potential preventative measures to reduce its re-emergence.

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Influence of innate immune activation on endocrine and metabolic pathways in infancy

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00542.2020 ◽

2021 ◽

Author(s):

Karen M O'Connor ◽

Minoo Ashoori ◽

Maria L Dias ◽

Eugene Dempsey ◽

Ken D. O'Halloran ◽

...

Keyword(s):

Neonatal Sepsis ◽

Metabolic Pathways ◽

Current Knowledge ◽

Later Life ◽

Innate Immune ◽

Adjunctive Treatment ◽

Future Research ◽

Term Infants ◽

Immune System Activation ◽

Increased Risk

Prematurity is the leading cause of neonatal morbidity and mortality worldwide. Premature infants often require extended hospital stays, with increased risk of developing infection compared with term infants. A picture is emerging of wide-ranging deleterious consequences resulting from innate immune system activation in the newborn infant. Those who survive infection have been exposed to a stimulus that can impose long-lasting alterations into later life. In this review, we discuss sepsis-driven alterations in integrated neuroendocrine and metabolic pathways and highlight current knowledge gaps in respect of neonatal sepsis. We review established biomarkers for sepsis and extend the discussion to examine emerging findings from human and animal models of neonatal sepsis that propose novel biomarkers for early identification of sepsis. Future research in this area is required to establish a greater understanding of the distinct neonatal signature of early and late-stage infection, to improve diagnosis, curtail inappropriate antibiotic use and promote precision medicine through a biomarker-guided empirical and adjunctive treatment approach for neonatal sepsis. There is an unmet clinical need to decrease sepsis-induced morbidity in neonates, to limit and prevent adverse consequences in later life and decrease mortality.

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Early-onset neonatal sepsis: Organism patterns between 2009 and 2014

Paediatrics & Child Health ◽

10.1093/pch/pxz073 ◽

2019 ◽

Vol 25 (7) ◽

pp. 425-431

Author(s):

Michael Sgro ◽

Douglas M Campbell ◽

Kaitlyn L Mellor ◽

Kathleen Hollamby ◽

Jaya Bodani ◽

...

Keyword(s):

Neonatal Sepsis ◽

Early Onset ◽

Neonatal Intensive Care ◽

Group B Streptococcus ◽

Neonatal Intensive Care Units ◽

Causative Organism ◽

Term Infants ◽

E Coli ◽

Group B ◽

Reported Data

Abstract Objective To evaluate trends in organisms causing early-onset neonatal sepsis (EONS). Congruent with recent reports, we hypothesized there would be an increase in EONS caused by Escherichia coli. Study Design National data on infants admitted to neonatal intensive care units from 2009 to 2014 were compared to previously reported data from 2003 to 2008. We report 430 cases of EONS from 2009 to 2014. Bivariate analyses were used to analyze the distribution of causative organisms over time and differences by gestational age. Linear regression was used to estimate trends in causative organisms. Results Since 2003, there has been a trend of increasing numbers of cases caused by E coli (P<0.01). The predominant organism was E coli in preterm infants and Group B Streptococcus in term infants. Conclusions With the majority of EONS cases now caused by E coli, our findings emphasize the importance of continued surveillance of causative organism patterns and developing approaches to reduce cases caused by E coli.

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Duration of Intrapartum Antibiotics for Group B Streptococcus on the Diagnosis of Clinical Neonatal Sepsis

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2013/525878 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Mark A. Turrentine ◽

Anthony J. Greisinger ◽

Kimberly S. Brown ◽

Oscar A. Wehmanen ◽

Melanie E. Mouzoon

Keyword(s):

Cohort Study ◽

Neonatal Sepsis ◽

Retrospective Cohort ◽

Group B Streptococcus ◽

Multivariate Logistic Regression Analysis ◽

Adjusted Relative Risk ◽

Multivariate Logistic Regression ◽

Clinical Sepsis ◽

Intrapartum Antibiotic ◽

Group B

Background. Infants born to mothers who are colonized with group B streptococcus (GBS) but received <4 hours of intrapartum antibiotic prophylaxis (IAP) are at-risk for presenting later with sepsis. We assessed if <4 hours of maternal IAP for GBS are associated with an increased incidence of clinical neonatal sepsis.Materials and Methods. A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ≥37-week gestation who presented in labor from January 1, 2003 through December 31, 2007 was performed. Infants diagnosed with clinical sepsis by the duration of maternal IAP received (< or ≥4-hours duration) were determined.Results. More infants whose mothers received <4 hours of IAP were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus 15 of 3,633 (0.4%), . Multivariate logistic regression analysis showed that treatment with ≥4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16–0.79, and .Conclusion. The rate of neonatal clinical sepsis is increased in newborns of GBS colonized mothers who receive <4 hours compared to ≥4 hours of IAP.

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PS-221 Lower Maternal/neonatal Vitamin D Levels Are Associated With Increased Risk Of Early Onset Neonatal Sepsis In Term Infants

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-307384.520 ◽

2014 ◽

Vol 99 (Suppl 2) ◽

pp. A192.3-A193

Author(s):

M Cetinkaya ◽

F Cekmez ◽

G Buyukkale ◽

T Erener-Ercan ◽

F Demir ◽

...

Keyword(s):

Vitamin D ◽

Neonatal Sepsis ◽

Early Onset ◽

Term Infants ◽

Increased Risk ◽

Vitamin D Levels

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Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants

Journal of Perinatology ◽

10.1038/jp.2014.146 ◽

2014 ◽

Vol 35 (1) ◽

pp. 39-45 ◽

Cited By ~ 50

Author(s):

M Cetinkaya ◽

F Cekmez ◽

G Buyukkale ◽

T Erener-Ercan ◽

F Demir ◽

...

Keyword(s):

Vitamin D ◽

Neonatal Sepsis ◽

Early Onset ◽

Term Infants ◽

Increased Risk ◽

Vitamin D Levels ◽

Lower Vitamin

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The Anesthetic Modality but Not the Mode of Delivery Seem to Modulate the Methylation Status of Cyclooxygenase-2 Promoter of the Newborns

American Journal of Perinatology ◽

10.1055/s-0041-1735898 ◽

2021 ◽

Author(s):

Suna Şerife Oğuz ◽

Gözde Hayriye Kanmaz Kutman ◽

Kemal Oğuz

Keyword(s):

Cesarean Section ◽

Inflammatory Diseases ◽

Methylation Status ◽

Mode Of Delivery ◽

Newborn Infants ◽

Epidemiological Data ◽

Obstetric Anesthesia ◽

Cyclooxygenase 2 ◽

Term Infants ◽

Increased Risk

Objective Cesarean section (CS) rates are high. Epidemiological data supports increased risk of inflammatory conditions in the offspring born by CS. Epigenetic alterations occurring during the perinatal period may account for this risk. Cyclooxygenase-2 (COX2) has strong implications for inflammatory diseases. The methylation of COX2 of newborn infants was compared with respect to their mode of delivery. Study Design Ninety healthy term infants born by vaginal delivery (VD), planned cesarean section (PCS), or emergency CS (ECS) were recruited (30 infants in each group). For obstetric anesthesia, local (LA), regional (RA), or general (GA) anesthesia were used. Carefully selected exclusion criteria were implemented to eliminate any confounders with potential epigenetic effects. Umbilical artery blood samples were collected. Demographic and clinical characteristics, folate and CRP levels, and mean methylation levels of the COX2 gene promoter were determined. Results Except the birth weight and maternal age parameters, VD, PCS, and ECS were similar. The methylation percentage of COX2 was higher in ECS (16.9 ± 5.1) than VD (14.5 ± 4.1) and PCS (14.8 ± 2.9), albeit p was 0.064. Because of the dual anesthetic modality populations (RA and GA) in PCS and ECS and the recent literature on anesthetics and epigenetics, the anesthetic modality groups were also analyzed. The methylation percentage of COX2 was significantly different between LA, RA, and GA groups (14.5 ± 4.1, 13.9 ± 2.8, and 17.0 ± 4.6, respectively, p = 0.012). Conclusion When the mode of delivery is the question of debate, the anesthetic modality should be remembered as an important epigenetic modulator. Key Points

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