Late-onset group B streptococcus infections and severe bronchopulmonary dysplasia in an extremely preterm born infant

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Infectious Diseases

Background:

• Extremely preterm infants face significant respiratory challenges, including bronchopulmonary dysplasia (BPD).
• Recurrent infections, such as group B Streptococcus (GBS), can exacerbate respiratory conditions in neonates.
• Mechanical ventilation is often required for prolonged periods in critically ill preterm infants.

Observation:

• A male infant born at 24 weeks gestation developed severe BPD requiring prolonged mechanical ventilation (155 days).
• The infant experienced five recurrent group B streptococcus (GBS) infections within the first four months of life.
• Respiratory status deteriorated with each GBS infection, complicating ventilator weaning.

Findings:

• High-dose methylprednisolone, administered per international guidelines, facilitated extubation at 7 months.
• A combination of intravenous penicillin and oral rifampicin eradicated persistent GBS infections after the fifth occurrence.
• The infant achieved respiratory independence by 22 months of age.

Implications:

• This case highlights the potential benefit of high-dose corticosteroids in managing severe BPD in extremely preterm infants.
• Effective antibiotic stewardship, including targeted therapy like rifampicin for GBS, is crucial for managing recurrent infections in vulnerable neonates.
• While respiratory outcomes improved, a 6-month delay in neurological development underscores the long-term morbidities associated with extreme prematurity and complications.