| Abstrakt: |
Objectives: Sepsis is an imporant cause of morbidity and mortality among newborn infants. Universal screening at 35-37 weeks gestation for maternal Group B Streptococcus (GBS) disease and the use of intrapartum antibiotic prophylaxis has resulted in substantial reduction of early onset GBS disease among newborn. Despite progress in prevention of perinatal GBS disease since the 1990s, GBS remains the leading cause of early-onset and important cause of late-onset neonatal sepsis. Early onset sepsis (within first week of life) is usually related to the vaginal colonization and is a consequence of vertical transmission during delivery. Late onset disease (LOD) can be acquired from the mother, environmental or nosocomial sources after birth (horizontal transmission). In some infants the source of infection is unclear. There are no clear guidelines for the prevention of late GBS disease. Severe LOD includes sepsis, meningitis, seizures, brain lesions at discharge, need for catecholamine support or mechanical ventilation. However, intrapartum antibiotic prophylaxis did not affect the prevalence of late onset sepsis but is associated with both delayed and milder presentation of disease. The aim of the prospective-retrospective study is to present the clinical course and treatment of newborns with early and late neonatal sepsis (NS) and meningitis caused by GBS treated in the Mother and Child Health Care Institute of Serbia in a ten-year period and to point out the importance of universal GBS screening, comprehensive intrapartum prophylaxis, rapid detection and adequate treatment of neonatal sepsis. Methods: Patients data in this prospective-retrospective study were obtained from medical documentation. Results: In the period from January 2007. to December 2016, 42 newborns with sepsis caused by GBS were treated at the Institute. Thity patients (71%) had early NS and 12 (29%) were treated for late sepsis. In 17 patients (41%) sepsis was proven by the isolation of GBS from the hemoculture and 25 (59%) had GBS isolation from other specimens with the presence of clinical signs and laboratory indicators of sepsis. Clinical signs of early sepsis were respiratory distress, altered general condition, seizures, abdominal distention, poor milk tolerance and fever. In patients with late sepsis anxiety, fever, convulsion, apnea, hypertonia, altered general and neurological conditions been reported. Respiratory insufficiency and the need for respiratory support were reported in 10 cases (24%). Meningitis was found in 8 newborns (19%), of which 6 had late sepsis. There were two lethal outcomes (5%). Conclusions: Universal screening and intrapartum antibiotic prophylaxis continue to be the main prevention of GBS disease. Rapid detection of neonatal infection and initiation of appropriate treatment (combination of ampicillin and aminoglycoside antibiotics) is necessary to minimize morbidity and mortality among newborns with GBS sepsis. Detection of early and late NS is certain clinical challenge and includes changes in clinical appearance, recognition of signs of systemic inflammatory response syndrome, pathological laboratory results and presence of maternal risk factors for GBS disease. Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. [ABSTRACT FROM AUTHOR] |
