Neonatal Group B Streptococcal Meningitis: Predictors for Poor Neurologic Outcome at 18 Months

Aim To find early predictors for poor neurodevelopmental outcome after neonatal group B streptococcal meningitis. Methods We retrospectively analyzed clinical characteristics of 23 patients with neonatal group B streptococcal meningitis and their neurodevelopmental outcome at 18 months. Available group B Streptococcus strains were serotyped and their genomes characterized. Results We found several differences between patients with early- (n = 5) and late-onset (n = 18) disease. Nine children had neurologic abnormalities at 18 months and 4 had epilepsy, all of them after late-onset disease. Most important risk factors for poor outcome were impaired consciousness at admission, hemodynamic instability, seizures, or abnormal electroencephalogram during the acute illness and abnormal neurologic and ophthalmologic examination at the end of treatment, whereas abnormalities in laboratory and imaging studies were not predictive. Hypervirulent serotype III, multilocus sequence type 17 group B Streptococcus was the predominant pathogen. Conclusions Neurodevelopmental impairment after neonatal group B streptococcal meningitis is likelier in those with clinical and neurophysiological features indicating worse disease severity.

Phylogenetic and Transmission Patterns of Extended-Spectrum β- Lactamase –Producing Escherichia Coli among Neonatal’s Gut Flora in Indonesia

This study aimed to explore the phylogenetic pattern of Extended-spectrum β-lactamase-producing Escherichia coli in the gut flora of neonatal into groups A, B1, B2, D and tracing the presence of spreading among the age group of neonatal. Multiplex PCR was conducted to classify the phylogenetic group of ESBL producing E. coli into groups of commensals (A, B1) and pathogen (B2, D). The spread of bacterial agents among the host (neonatal) was conducted by the RAPD-PCR method with two random primers. Among 34 bacterial isolates were identified among early neonatal group A (22,2%), B1 (11,1%), B2 (22,2%) D (33,3%) and postneonatal groups A (8%), B1 (4%), B2 (36%) D (40%). It was not a statistically significant difference (p=0.388). The dominance of pathogenic groups B2 and D as many as 70,6%. From 34 samples was found 34 types of RAPD indicated there were not any bacterial spread among neonatal. The ESBL producing E. coli among early neonatal and postneonatal were dominated by the pathogenic group of B2 and D (total=70,6%), but they were not statistically significant. There was not any spreading of bacterial agents among individual gut flora of neonatal.

Barriers to the efficient implementation of the neonatal Group B Streptococcal (GBS) disease prevention programme. A retrospective documentation analysis, eastern Croatia

Objectives. To analyse the implementation status of the neonatal Group B Streptococcal (GBS) disease prevention programme in the town of Osijek area, eastern Croatia.Methods. A retrospective analysis of archive documentation on an annual basis (2016). A conversation with gynaecologists was conducted to complement this analysis.Results. There was a prevalent proportion of the GBS swab culture findings (3/4) of cervical origin, as gynaecologists use this technique in a wide range of risk conditions related to pregnancy and as a screening technique, as well. The universal screening was performed in almost every second pregnant women (44.7%). This proportion could be a higher, counting on that the cervical swab sampling is customised among gynaecologists. The approximate prevalence of maternal GBS colonisation was above 6%. The prevalence of neonatal sepsis was 6.46%. In a major part of new-borns with sepsis, the infectious agent was unknown (92%). The GBS caused sepsis was found in 7 (5%) cases. Infectious agents other than GBS were found in 4 (3%) cases.Conclusions. The problem oriented hospital documentation, supported by the ICT system, is a prerequisite for a continuous monitoring of implementation of the neonatal GBS disease prevention programme.

Healthcare without borders: A cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng Province of South Africa

Background Human migration is a worldwide phenomenon that receives considerable attention from the media and healthcare authorities alike. A significant proportion of children seen at public sector health facilities in South Africa (SA) are immigrants, and gaps have previously been noted in their healthcare provision. The objective of the study was to describe the characteristics and differences between the immigrant and SA children admitted to Kalafong Provincial Tertiary Hospital (KPTH), a large public sector hospital in the urban Gauteng Province of SA. Methods and findings A cross-sectional study was conducted over a 4-month period during 2016 to 2017. Information was obtained through a structured questionnaire and health record review. The enrolled study participants included 508 children divided into 2 groups, namely 271 general paediatric patients and 237 neonates. Twenty-five percent of children in the neonatal group and 22.5% in the general paediatric group were immigrants. The parents/caregivers of the immigrant group had a lower educational level (p < 0.0001 neonatal and paediatric), lower income (neonatal p < 0.001; paediatric p = 0.024), difficulty communicating in English (p < 0.001 neonatal and paediatric), and were more likely residing in informal settlements (neonatal p = 0.001; paediatric p = 0.007) compared to the SA group. In the neonatal group, there was no difference in the number of antenatal care (ANC) visits, type of delivery, gestational age, and birth weight. In the general paediatric group, there was no difference in immunisation and vitamin A supplementation coverage, but when comparing growth, the immigrant group had more malnutrition compared to the SA group (p = 0.029 for wasting). There was no difference in the prevalence of maternal human immunodeficiency virus (HIV) infection, with equally good prevention of mother-to-child transmission (PMTCT) coverage. There was also no difference in reported difficulties by immigrants in terms of access to healthcare (neonatal p = 0.379; paediatric p = 0.246), although a large proportion (10%) of the neonates of immigrant mothers were born outside a medical facility. Conclusions Although there were health-related differences between immigrant and SA children accessing in-hospital care, these were fewer than expected. Differences were found in parental educational level and socioeconomic factors, but these did not significantly affect ANC attendance, delivery outcomes, immunisation coverage, HIV prevalence, or PMTCT coverage. The immigrant population should be viewed as a high-risk group, with potential problems including suboptimal child growth. Health workers should advocate for all children in the community they are serving and promote tolerance, respect, and equal healthcare access.

Neonatal Group B streptococcal osteomyelitis and suppurative arthritis: A case report

Neonatal sepsis contributes significantly to neonatal morbidity and mortality. Group B streptococcus (GBS) is not a frequent cause of neonatal sepsis in India. Late onset sepsis by GBS presenting as focal infection like osteomyelitis is seen in only 3% of the total GBS sepsis profile in neonates. Here, we report a rare case of neonatal osteomyelitis with septic arthritis caused by GBS at an unusual site, the clavicle and sternoclavicular joint.

1300. ACOG Committee Opinion #797 and the Dose of Intrapartum Vancomycin: a Potential Danger to Mother and Newborn Alike

Background Intra-partum (IP) IV vancomycin (VAN) 20 mg/kg every 8 hours is proposed by #797 for the prevention of early onset neonatal group B streptococcal disease (GBS), a recommendation for which the basis of scientific merit is poor. The goal of our study was to analyze the sparsely sampled published data and raise awareness about the underlying risk of VAN toxicity with this dosing approach. Methods Plasma and cord-blood concentration-time data of IV VAN given to mothers in the IP period was analyzed. 5000 Monte Carlo runs were conducted to simulate maternal/fetal exposure (AUC0-24; 24-48) for doses of 1500, 1750 and 2000 mgs q8h and for possible birth times at two-hour intervals. Neonatal VAN clearance was not possible to determine; hence, we used a validated PK model to calculate exposure for the first 24h of life for gestational ages (GA) of 33 to 40 weeks. The AUC range of 400 – 600, and &gt; 600 mg*h/L were considered for indices of efficacy and toxicity, respectively. Results Estimates from 30 pairs of serum and cord-blood concentrations analyzed with a 2-compartment model are shown in Table 1. Maternal VAN exposures seem acceptable up to 2 IP doses given with mean (SD) AUC0-24 of 394 (140), 474 (167), and 540 (193) mg*h/L for the 1500, 1750 and 2000 mg regimens. Most mothers (up to 83%) who receive three or more doses will be subjected to nephrotoxic exposures (Figure 1.). Neonatal evaluations indicate similarly low PTAs for the three dosing regimens when the efficacy target is considered (Figure 2. A). On the other hand, the PTAs for potentially nephrotoxic exposure is expected to reach undesirable levels when three or more doses were to be administered. The risk is profoundly high in GA of 33 to 35 weeks and birth times beyond 20 hours after the initiation of intra-partum prophylaxis (Figure 2. B). Figure 1. Figure 2.A Figure 2.B Conclusion Current recommendations by #797 for dosing of vancomycin pose significant risk to mother and newborn alike, especially in cases with lengthy duration of labor. Based on our results, maternal therapeutic drug monitoring for all cases requiring more than two doses should be considered. With the proposed dosing regimen going un-adjusted, 1 out of 4 newborns and 4 out of 5 mothers may be subjected to nephrotoxic exposures in prolonged labor. Table 1. Disclosures All Authors: No reported disclosures