Early onset sepsis continues to place newborns at risk

Group B streptococci (GBS) and Escherichia coli continue to put newborns at risk for sepsis despite recommendations for screening and prophylaxis during pregnancy.

Recommended universal screening of pregnant women and intrapartum chemoprophylaxis for those with GBS colonization have substantially reduced the rate of early onset neonatal sepsis. Prospective surveillance of a national cohort of nearly 400,000 live births, however, revealed missed opportunities for prevention of GBS and the continuing challenge of E coli infection. The findings are reported in Pediatrics.

Data on 396,586 infants born over a 4-year period were reviewed. Early onset sepsis and early onset meningitis were defined by positive culture results for blood and cerebrospinal fluid drawn from infants within 72 hours of birth and receiving antibiotic treatment for 5 or more days.

Early onset sepsis was identified in 389 infants (0.98 cases per 1,000 live births); 51% were preterm and 190 were term. Infection rates increased with decreasing gestational age and birth weight. The most frequently isolated pathogens were GBS (43%) and E coli (29%). GBS was the most common pathogen in term infants and E coli the most common in preterm infants.

Despite recommended universal antenatal screening for GBS, only 67% of mothers of infected term infants and 58% of mothers of infected preterm infants had been screened. Furthermore, only 76% of mothers colonized with GBS received chemoprophylaxis during pregnancy.

Although 77% of infected infants required intensive care, 20% of term infants received care in the normal newborn nursery. Sixteen percent of infected infants died, most often of E coli infection.

GBS remains the most common pathogen in term infants with early onset sepsis, but E coli has become the most common in preterm infants. Prevention strategies for early onset E coli disease are needed, the researchers advise.

Stoll BJ, Hansen NI, Sánchez PJ, et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics. 2011;127(5):817-826.