[Invasive pneumococcal infection in 5 newborns, 1996-2004]

At the Máxima Medisch Centrum in Veldhoven, The Netherlands, neonatal sepsis caused by invasive Streptococcus pneumoniae infection was diagnosed in 5 neonates between 1996 and 2004. This infection is relatively rare and its clinical features are variable, but often particularly severe and fulminant as was the case in 2 of the 5 children, one of whom died and the other was left with serious psychomotor retardation. The other 3 recovered fully. The child who died and one of the children who recovered are described in some detail. They were both prematurely born neonates, a girl and a boy, who presented almost immediately after birth with an early-onset sepsis caused by S. pneumoniae. In both cases neonatal cultures as well as maternal vaginal swabs were positive for S. pneumoniae growth. 2 different patients had other risk factors for peripartal infection. Neonatal pneumococcal infections are most likely transmitted trough the maternal vaginal tract. Maternal vaginal colonization is rare (0.11%), but associated with a high risk of transmission to the newborn. Asymptomatic neonatal colonization was not observed. In light of the likelihood of a high rate of transmission and subsequent infection, peripartal prophylactic antibiotic treatment is advised for all mothers with proven vaginal S. pneumoniae colonization. If this is not given or is not effective, then in contrast with the policy on patients with group B streptococcal colonization, prophylactic antibiotic treatment is advocated for all neonates born to colonized mothers. Amoxicillin is the preferred treatment. In areas of increasing macrolide resistance, erythromycin should only be advised in cases of penicillin allergy.