CASE REPORT
Two cases of neonatal pneumococcal septicemia HANSJOHNSSON,' STAFFAN &RGSTROM,'
UWE
EWALD' AND ANNA S C H W A d
From the Departments of 'Pediatrics, 'Obstetrics and Gynecology and 3Clinical Bacteriology, University Hospital, Uppsala, Sweden.
Actu Obstet Gynecol Scand 1992; 11 72-13
Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. Two recent cases that occurred within it short period of time are described. They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis. Key wwrds: neonatal disease; neonatal septicemia; pneumococcal infection Suhrnirted March 21, 1441 Acwpted November 8, 1941
Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. The recent occurrence of two cases in our neonatal unit, prompted this report.
1990 pneumococci were isolated in only one cervical culture (case 2 ) . During the same period no case of neonatal pneumococcal bacteremia was registered prior to the two presented cases, which occurred in February and March 1990. The pneumococcal isolates from the positive blood cultures were typed at the National Bacteriological Laboratory, Stockholm. Sweden.
Case reports
Case
At the University Hospital, Uppsala, Sweden, some 4,000 infants are born annually (4,016 in 1989). Preterm births account for 4% of these. In the neonatal intensive care unit referred medical and surgical cases are treated together with infants born at the hospital. As an average for 1987-lY89, the incidence of neonatal septicemia with onset within 7 days of birth was 0.86/1,000 live births. From 1982, the year computerized records became available, to December
The mother was 37-year-old, V-gravida IV-para, with ulcerative colitis of 10 years' duration but without symptoms or treatment during the present pregnancy. Following an amniocentesis in the 15th week of gestation she noticed intermittent leakage of amniotic fluid. One month before delivery she was treated with cefadroxil because of growth of GBS in a cervical culture. On admission to the maternity ward she had a sore throat, earache and fever (37.738.O"C). A girl was born after 27 2/7 weeks of gestation by spontaneous vaginal delivery with blood-stained, but not foul smelling, amniotic fluid. Birth weight was 1128 g and Apgar scores were 4 and 6 at 1 and 5 min, respectively. Initially she was ventilated by mask and bag. A t 12 min of age she was intubated and supported by a ventilator. An
Abbreviations: Continuous Positive Airway Pressure (CPAP), C-Reactive Protein (CRP). Group B Streptococci (GBS). Actu Ohstet Gynrtol Scund 71 (1992)
I
+
Two cases of neonatal pnrumococcal septicemia umbilical arterial catheter was inserted and a blood sample drawn for culture. No other cultures were taken. Antibiotic treatment with ampicillin and gentamicin was started. The first arterial blood gas measurement at 30 min of age showed a pH of 6.92 and a base deficit of 15.3. An X-ray of the lungs disclosed changes compatible with infantile respiratory distress syndrome. Despite a high insufflation pressure and a high inspired oxygen concentration, neither adequate ventilation nor oxygenation were achieved, and the girl died at an age of 19 hours. Pneumococci type 6, sensitive to ampicillin, were isolated from the blood culture. Autopsy revealed scattered areas of bronchopneumonia in the lungs. Post-mortem cultures from the blood and internal organs were negative.
Case 2 The mother was a healthy 20-year-old primipara. The pregnancy was normal until 32 weeks and 6 days postmenstrually, when the fetal membranes ruptured. The amniotic fluid was clear. Two days later labor began and a boy was delivered vaginally, in cephalic presentation, 53 hours after the membrane rupture. The amniotic fluid was meconium stained. Birth weight was 2000 g and Apgar scores 5 and 8 at 1 and 5 min, respectively. Initially he was in good condition, but at 2 hours of age he started to have attacks of apnea with bradycardia. A pulmonary X-ray showed changes compatible with the pulmonary adaptation syndrome (‘wet lungs’) or infection. CRP was 86 mg/l (normal value
Two cases of neonatal pneumococcal septicemia HANSJOHNSSON,' STAFFAN &RGSTROM,'
UWE
EWALD' AND ANNA S C H W A d
From the Departments of 'Pediatrics, 'Obstetrics and Gynecology and 3Clinical Bacteriology, University Hospital, Uppsala, Sweden.
Actu Obstet Gynecol Scand 1992; 11 72-13
Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. Two recent cases that occurred within it short period of time are described. They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis. Key wwrds: neonatal disease; neonatal septicemia; pneumococcal infection Suhrnirted March 21, 1441 Acwpted November 8, 1941
Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. The recent occurrence of two cases in our neonatal unit, prompted this report.
1990 pneumococci were isolated in only one cervical culture (case 2 ) . During the same period no case of neonatal pneumococcal bacteremia was registered prior to the two presented cases, which occurred in February and March 1990. The pneumococcal isolates from the positive blood cultures were typed at the National Bacteriological Laboratory, Stockholm. Sweden.
Case reports
Case
At the University Hospital, Uppsala, Sweden, some 4,000 infants are born annually (4,016 in 1989). Preterm births account for 4% of these. In the neonatal intensive care unit referred medical and surgical cases are treated together with infants born at the hospital. As an average for 1987-lY89, the incidence of neonatal septicemia with onset within 7 days of birth was 0.86/1,000 live births. From 1982, the year computerized records became available, to December
The mother was 37-year-old, V-gravida IV-para, with ulcerative colitis of 10 years' duration but without symptoms or treatment during the present pregnancy. Following an amniocentesis in the 15th week of gestation she noticed intermittent leakage of amniotic fluid. One month before delivery she was treated with cefadroxil because of growth of GBS in a cervical culture. On admission to the maternity ward she had a sore throat, earache and fever (37.738.O"C). A girl was born after 27 2/7 weeks of gestation by spontaneous vaginal delivery with blood-stained, but not foul smelling, amniotic fluid. Birth weight was 1128 g and Apgar scores were 4 and 6 at 1 and 5 min, respectively. Initially she was ventilated by mask and bag. A t 12 min of age she was intubated and supported by a ventilator. An
Abbreviations: Continuous Positive Airway Pressure (CPAP), C-Reactive Protein (CRP). Group B Streptococci (GBS). Actu Ohstet Gynrtol Scund 71 (1992)
I
+
Two cases of neonatal pnrumococcal septicemia umbilical arterial catheter was inserted and a blood sample drawn for culture. No other cultures were taken. Antibiotic treatment with ampicillin and gentamicin was started. The first arterial blood gas measurement at 30 min of age showed a pH of 6.92 and a base deficit of 15.3. An X-ray of the lungs disclosed changes compatible with infantile respiratory distress syndrome. Despite a high insufflation pressure and a high inspired oxygen concentration, neither adequate ventilation nor oxygenation were achieved, and the girl died at an age of 19 hours. Pneumococci type 6, sensitive to ampicillin, were isolated from the blood culture. Autopsy revealed scattered areas of bronchopneumonia in the lungs. Post-mortem cultures from the blood and internal organs were negative.
Case 2 The mother was a healthy 20-year-old primipara. The pregnancy was normal until 32 weeks and 6 days postmenstrually, when the fetal membranes ruptured. The amniotic fluid was clear. Two days later labor began and a boy was delivered vaginally, in cephalic presentation, 53 hours after the membrane rupture. The amniotic fluid was meconium stained. Birth weight was 2000 g and Apgar scores 5 and 8 at 1 and 5 min, respectively. Initially he was in good condition, but at 2 hours of age he started to have attacks of apnea with bradycardia. A pulmonary X-ray showed changes compatible with the pulmonary adaptation syndrome (‘wet lungs’) or infection. CRP was 86 mg/l (normal value
