Early onset neonatal sepsis

The burden of group B streptococcal and E. coli disease continues

Barbara J. Stoll, Nellie I. Hansen, Pablo J. Sánchez, Roger G. Faix, Brenda B. Poindexter, Krisa P. Van Meurs, Matthew J. Bizzarro, Ronald N. Goldberg, Ivan D. Frantz, Ellen C. Hale, Seetha Shankaran, Kathleen Kennedy, Waldemar A. Carlo, Kristi L. Watterberg, Edward F. Bell, Michele C. Walsh, Kurt Schibler, Abbot R. Laptook, Andi L. Shane, Stephanie J. Schrag & 2 others Abhik Das, Rosemary D. Higgins

Research output: Contribution to journalArticle

472 Citations (Scopus)

Abstract

BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was de-fined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006 -2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.

Original languageEnglish
Pages (from-to)817-826
Number of pages10
JournalPediatrics
Volume127
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Escherichia coli
Live Birth
Infection
Mothers
Premature Infants
Chemoprevention
National Institute of Child Health and Human Development (U.S.)
Neonatal Sepsis
Escherichia coli Infections
Streptococcal Infections
Nurseries
Critical Care
Birth Weight
Cerebrospinal Fluid
Sepsis
Newborn Infant
Guidelines
Anti-Bacterial Agents
Morbidity
Mortality

Keywords

  • Escherichia coli infection
  • Group B streptococcal disease
  • Neonatal sepsis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Stoll, B. J., Hansen, N. I., Sánchez, P. J., Faix, R. G., Poindexter, B. B., Van Meurs, K. P., ... Higgins, R. D. (2011). Early onset neonatal sepsis: The burden of group B streptococcal and E. coli disease continues. Pediatrics, 127(5), 817-826. https://doi.org/10.1542/peds.2010-2217

Early onset neonatal sepsis : The burden of group B streptococcal and E. coli disease continues. / Stoll, Barbara J.; Hansen, Nellie I.; Sánchez, Pablo J.; Faix, Roger G.; Poindexter, Brenda B.; Van Meurs, Krisa P.; Bizzarro, Matthew J.; Goldberg, Ronald N.; Frantz, Ivan D.; Hale, Ellen C.; Shankaran, Seetha; Kennedy, Kathleen; Carlo, Waldemar A.; Watterberg, Kristi L.; Bell, Edward F.; Walsh, Michele C.; Schibler, Kurt; Laptook, Abbot R.; Shane, Andi L.; Schrag, Stephanie J.; Das, Abhik; Higgins, Rosemary D.

In: Pediatrics, Vol. 127, No. 5, 05.2011, p. 817-826.

Research output: Contribution to journalArticle

Stoll, BJ, Hansen, NI, Sánchez, PJ, Faix, RG, Poindexter, BB, Van Meurs, KP, Bizzarro, MJ, Goldberg, RN, Frantz, ID, Hale, EC, Shankaran, S, Kennedy, K, Carlo, WA, Watterberg, KL, Bell, EF, Walsh, MC, Schibler, K, Laptook, AR, Shane, AL, Schrag, SJ, Das, A & Higgins, RD 2011, 'Early onset neonatal sepsis: The burden of group B streptococcal and E. coli disease continues', Pediatrics, vol. 127, no. 5, pp. 817-826. https://doi.org/10.1542/peds.2010-2217
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP et al. Early onset neonatal sepsis: The burden of group B streptococcal and E. coli disease continues. Pediatrics. 2011 May;127(5):817-826. https://doi.org/10.1542/peds.2010-2217
Stoll, Barbara J. ; Hansen, Nellie I. ; Sánchez, Pablo J. ; Faix, Roger G. ; Poindexter, Brenda B. ; Van Meurs, Krisa P. ; Bizzarro, Matthew J. ; Goldberg, Ronald N. ; Frantz, Ivan D. ; Hale, Ellen C. ; Shankaran, Seetha ; Kennedy, Kathleen ; Carlo, Waldemar A. ; Watterberg, Kristi L. ; Bell, Edward F. ; Walsh, Michele C. ; Schibler, Kurt ; Laptook, Abbot R. ; Shane, Andi L. ; Schrag, Stephanie J. ; Das, Abhik ; Higgins, Rosemary D. / Early onset neonatal sepsis : The burden of group B streptococcal and E. coli disease continues. In: Pediatrics. 2011 ; Vol. 127, No. 5. pp. 817-826.
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abstract = "BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was de-fined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006 -2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43{\%}, 0.41 per 1000 LBs) and E coli (29{\%}, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73{\%}); 81{\%} with E coli were preterm. Mothers of 67{\%} of infected term and 58{\%} of infected preterm infants were screened for GBS, and results were positive for 25{\%} of those mothers. Only 76{\%} of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77{\%} of infected infants required intensive care, 20{\%} of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33{\%}). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.",
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T1 - Early onset neonatal sepsis

T2 - The burden of group B streptococcal and E. coli disease continues

AU - Stoll, Barbara J.

AU - Hansen, Nellie I.

AU - Sánchez, Pablo J.

AU - Faix, Roger G.

AU - Poindexter, Brenda B.

AU - Van Meurs, Krisa P.

AU - Bizzarro, Matthew J.

AU - Goldberg, Ronald N.

AU - Frantz, Ivan D.

AU - Hale, Ellen C.

AU - Shankaran, Seetha

AU - Kennedy, Kathleen

AU - Carlo, Waldemar A.

AU - Watterberg, Kristi L.

AU - Bell, Edward F.

AU - Walsh, Michele C.

AU - Schibler, Kurt

AU - Laptook, Abbot R.

AU - Shane, Andi L.

AU - Schrag, Stephanie J.

AU - Das, Abhik

AU - Higgins, Rosemary D.

PY - 2011/5

Y1 - 2011/5

N2 - BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was de-fined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006 -2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.

AB - BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was de-fined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006 -2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge.

KW - Escherichia coli infection

KW - Group B streptococcal disease

KW - Neonatal sepsis

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DO - 10.1542/peds.2010-2217

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