Early-onset neonatal pneumococcal sepsis syndrome

To report two cases of severe early-onset neonatal sepsis due to Streptococcus pneumoniae, including, to our knowledge, the first reported case of sepsis due to penicillin-resistant S. pneumoniae presenting as early-onset neonatal sepsis.

Case reports.

A level III military and civilian neonatal intensive care unit.

Two infants (gestational ages of 38 and 35 wks), both of whom presented shortly after birth with severe septic shock presumed to be due to group B streptococcus.

Both infants were treated with high-frequency oscillatory ventilation and inhaled nitric oxide, with one infant requiring venoarterial extracorporeal membrane oxygenation.

Cultures of blood specimens from both infants yielded S. pneumoniae. For one infant, antibiotic sensitivity testing demonstrated resistance to penicillin, erythromycin, and trimethoprim/sulfamethoxazole. After treatment, both infants recovered well with normal results of examinations and neural imaging studies at the time of hospital discharge.

Clinicians should consider S. pneumoniae as a possible cause of fulminant nonresponsive sepsis in neonates. In areas where antimicrobial-resistant S. pneumoniae is prevalent, when culture results are known, or with a clinical course unresponsive to ampicillin, septic infants may require the addition of a penicillinase-resistant antibiotic to their therapeutic regimen until results of antibiotic sensitivity testing are known. Early transfer to a center with extracorporeal membrane oxygenation should be considered for symptomatic neonates.