Search

Highlights • Antenatal testing and intrapartum antibiotic prophylaxis (IAP) with penicillin has reduced the incidence of invasive neonatal Group B streptococcus disease by up to 80%. • Countries persisting with a ‘risk based’ approach to IAP have not seen similar falls, and in some cases (e.g. the UK) have seen a rise in the incidence of disease. • Intrapartum antibiotic prophylaxis produces short-term alterations in the neonatal microbiome, but none so far are considered to be of clinical significance. • The cornerstone of neonatal care remains prompt recognition of signs of infection and administration of benzylpenicillin and gentamicin, pending culture results. •A vaccine against GBS infection would have many advantages but there are still many barriers to be overcome before one becomes available., Group B Streptococcus, a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. The incidence of early onset disease has fallen markedly in countries that test women for carriage at 35–37 weeks of pregnancy and then offer intrapartum prophylaxis with penicillin during labour. Countries that do not test, but instead employ a risk factor approach, have not seen a similar fall. There are concerns about the effect on the neonatal microbiome of widespread use of antibiotic prophylaxis during labour, but so far the effects seem minor and temporary. Vaccination against GBS would be acceptable to most women and GBS vaccines are in the early stages of development. Tweetable abstract: Group B Strep is a key cause of infection, death and disability in young babies. Antibiotics given in labour remain the mainstay of prevention, until a vaccine is available.

Background: Sidra Medicine is the first dedicated Children and Maternity hospital in the State of Qatar. This paper describes the preparations for and results of activating quaternary neonatal surgical services in a brand new, "greenfield" hospital. We believe that these are the first published national results of neonatal general surgical services from the Gulf region. Methods: A review of surgical babies below four weeks corrected age from 1st of April 2018 – 31st of March 2020 was undertaken. Patient demographics, primary diagnosis, surgical procedures, 30-day postoperative mortality, overall mortality, and cause of death were recorded. Results: One hundred and sixty-nine babies (169) were identified (44.4% term and 55.6% preterm). Major surgery included laparotomy (76), congenital diaphragmatic hernia repair (20), surgery for anorectal malformations (25), and esophageal atresia (13). One set of conjoined twins were also separated successfully. Fourteen babies died, resulting in overall mortality of 8.3 %. Excluding babies who died of life-limiting conditions, two babies died within 30 days of surgery, resulting in 30 days postoperative mortality rate of 1.2 %. Conclusions: The neonatal surgical mortality rate is comparable with those from top international centers. This low rate could be attributed to the high level of expertise preceded by months of preparations.

Background A large proportion of neonates are treated for presumed bacterial sepsis with broad spectrum antibiotics even though their blood cultures subsequently show no growth. This study aimed to investigate PCR-based methods to identify pathogens not detected by conventional culture. Methods Whole blood samples of 208 neonates with suspected early onset sepsis were tested using a panel of multiplexed bacterial PCRs targeting Streptococcus pneumoniae, Streptococcus agalactiae (GBS), Staphylococcus aureus, Streptococcus pyogenes (GAS), Enterobacteriaceae, Enterococcus faecalis, Enterococcus faecium, Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium, a 16S rRNA gene broad-range PCR and a multiplexed PCR for Candida spp. Results Two-hundred and eight samples were processed. In five of those samples, organisms were detected by conventional culture; all of those were also identified by PCR. PCR detected bacteria in 91 (45%) of the 203 samples that did not show bacterial growth in culture. S. aureus, Enterobacteriaceae and S. pneumoniae were the most frequently detected pathogens. A higher bacterial load detected by PCR was correlated positively with the number of clinical signs at presentation. Conclusion Real-time PCR has the potential to be a valuable additional tool for the diagnosis of neonatal sepsis.

ObjectiveTo describe the epidemiology of neonatal infection over the past decade in UK neonatal units.DesignRetrospective analysis of prospectively collected infection surveillance network data from 2005 to 2014.Setting30 neonatal units in the UK.PatientsNewborns on participating neonatal units who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of appropriate antibiotics.Results2171 episodes of neonatal infection in 1922 infants were recorded. The incidence of infection was 6.1/1000 live births and 48.8/1000 neonatal admissions (2.9 and 23.5 respectively if coagulase-negative staphylococci (CoNS) cultures excluded). The incidence of infection showed a statistically significant reduction over time with reductions in the rates of both early-onset sepsis (EOS) and late-onset sepsis (LOS).The majority of episodes (76%) represented LOS (diagnosed > 48 hours after birth), and infection was more common in premature (Escherichia coli (18%) for EOS, while E. coli (15%), Staphylococcus aureus (14%) and CoNS were prominent causes of LOS.ConclusionsThis paper describes the epidemiology of neonatal infection in the UK over the past decade. These data enable benchmarking of practice and inform areas of future research and guideline development. The results support the hypothesis that the introduction of infection prevention care bundles and antibiotic stewardship programmes in the UK has reduced the burden of LOS.

ObjectiveTo define the susceptibilities of the common causative pathogens of neonatal sepsis in the UK.DesignRetrospective analysis of the prospectively collected neonIN infection surveillance network data between 2005 and 2014.Setting30 neonatal units in the UK.PatientsNewborns admitted to participating neonatal units who return a positive blood, cerebrospinal fluid or urine culture and are treated with at least 5 days of appropriate antibiotics.Results1568 isolates with recorded antimicrobial data were collected including 328 early-onset sepsis (EOS) isolates and 1240 late-onset sepsis (LOS) isolates. The majority of EOS pathogens (>92%) were susceptible to the four empirical commonly used antimicrobial combinations (eg, 93% for benzylpenicillin/gentamicin), while LOS pathogens demonstrated higher levels of resistance (eg, 89% for flucloxacillin/gentamicin). Among infantsConclusionsThis analysis provides insights into the patterns of antimicrobial resistance among UK neonatal pathogens. These data will inform areas of future research and can be used to update national evidence-based guidelines on antimicrobial usage.

De novo guidance on the management of Gram-negative bacteria outbreaks in UK neonatal units was developed in 2012 by a Department of Health, England Antimicrobial Resistance and Healthcare Associated Infection working group. The recommendations included activation of an organisational response and establishing a control team when an outbreak is suspected; screening for the specific organism only during an outbreak; undertaking multidisciplinary reviews of cleaning routines, hand hygiene and Gram-negative bacteria transmission risks; considering deep-cleaning; cohorting colonised and infected babies preferably but not necessarily in isolation cubicles; and considering reducing beds or closing a unit to new admissions as a way of improving spacing and staff:patient ratios until the outbreak is under control. The group advised establishing mechanisms to communicate effectively across the network; informing parents of the outbreak as early as possible, and providing prewritten ‘infection outbreak’ information sheets. For prevention of outbreaks, the group advised meeting national staffing and cot-spacing requirements; following a Water Action Plan; using infection reduction care bundles and benchmarking; and introducing breast milk early and limiting antibiotic use.

AimTo compare continuous intravenous infusions of vancomycin in achieving desired therapeutic plasma concentrations against an intermittent bolus regimen.MethodData were collected for all babies who received a continuous infusion of vancomycin on our Neonatal Intensive Care Unit (NICU) between October 2014 and March 2015. The regimen is based on that of another hospital (Hospital A) and comprised of a loading dose of 15 mg/kg over 1 hour followed by a continuous infusion of 20–50 mg/kg/day according to creatinine and corrected gestational age (CGA). The desired therapeutic range is 15–25 mg/L. The data recorded were date and time vancomycin was commenced, corrected gestational age (CGA), day of life and creatinine level at commencement, and the dose administered in mg/kg/day. Plasma concentrations were recorded as first, second or subsequent. Babies who switched from intermittent regimen were excluded. Results were analysed according to plasma concentration i.e. first, second or subsequent and stratified by CGA, day of life and creatinine level.All concentrations were obtained retrospectively for the period January to July 2014 when vancomycin was administered by intermittent bolus regimen to allow comparison of effectiveness.The doses of vancomycin were prepared at ward level by trained neonatal nurses as there is no aseptic facility onsite.We also compared our findings with those of another hospital from 2012.Results49 babies received continuous vancomycin infusions and 115 plasma concentrations were analysed.Overall 62% of concentrations were within desired therapeutic range. This comprised 60.8% of first concentration, 60% of second concentration and 65.6% of subsequent concentrations. In relation to gestational age, 55.9% of concentrations for those 23–28+6 weeks CGA, 59.4% of concentrations for those 29–34+6 weeks CGA and 70.2% of concentrations for those >35 weeks CGA were in the therapeutic range.84.6% of concentrations for those 0–6 days old, 58% of concentrations for those 7–28 days old and 60% of concentrations for those >29 days old were in therapeutic range. 62% of concentrations for those with a Cr70 micromol/L were in the desired therapeutic range.Adjusting the data to allow for 10% variability in the target range achieved 71.3% of all concentrations in desired therapeutic range (13.5–27.5 mg/L).Compared to the plasma concentrations obtained on intermittent bolus regimen the percentage of concentrations in the desired therapeutic range has increased from 28% to 62%.Compared to the other hospital's data, the percentage of concentrations in the desired therapeutic range is lower at 62% compared to their 77%.ConclusionContinuous infusions of vancomycin are more effective than intermittent bolus dosing in achieving desired therapeutic concentrations. Stratification of results has not shown any appreciable difference between the groups receiving vancomycin. However, extrapolation of our findings to those from other work, where prefilled syringes prepared in pharmacy are used is limited. It is known that there is significant variability from the desired target concentration of syringes prepared at ward level. There is a need to look at procuring prefilled vancomycin syringes and undertaking a re-audit.

Group B streptococcus (GBS) is the commonest cause of early onset sepsis in UK newborns. Several risk factors for early onset GBS sepsis (EOGBS) have been described. The presence of these risk factors provides an opportunity for intrapartum antibiotic prophylaxis (IAP) and forms the basis of current UK EOGBS prevention guidance. Having observed poor compliance with national guidelines in a review of EOGBS cases within the UK Neonatal Infection Surveillance Network (NeonIN), we reviewed 14 NeonIN unit guidelines. We found substantial variation in recommendations within and between units on indications for IAP and treatment of asymptomatic neonates, and discrepancies between obstetric and neonatal guidelines, potentially increasing infants’ risk of infection. The lack of high quality evidence in this area and related ambiguity in national guidance may have contributed to diverse local approaches. A common approach would permit prospective evaluation of an EOGBS prevention strategy, generating an evidence base to benefit future guidelines.

Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use can be life-saving, however, injudicious use drives antibiotic resistance and contributes to the development of abnormal faecal flora and subsequent immune dysregulation. Neonatal units are a high risk area for the selection and transmission of multi-resistant organisms. Very few new antibiotics with activity against Gram-negative bacteria are under development, and no significantly new Gram-negative antibiotics will be available in the next decade. This review seeks to summarise current practice, and suggests restrictive antibiotic strategies based on epidemiological data from recently published UK neonatal infection surveillance studies.

Attenuated antibody responses have been reported in preterm infants who received neonatal dexamethasone treatment. The duration of immunosuppression may extend into later infancy. This study assessed the immune response of former preterm infants to a single meningococcal serogroup C conjugate (MCC) immunisation given after infancy. A cohort of 49 toddlers born at less than 33 weeks' gestation were given an initial dose of MCC vaccine at a median age of 13 months; 11 had received dexamethasone in the neonatal period. Sera obtained 4 weeks post immunisation were analysed for serum bactericidal antibody (SBA) and serogroup C-specific IgG antibody concentrations. Immune responses were compared with those of an historical cohort of 70 term toddlers given a single dose of the same vaccine at age 13 months. An SBA titre of > or =8 was taken to indicate a protective response. Following a single MCC dose, the SBA geometric mean titre (GMT) for former preterm infants was 249 (95% C.I. 111, 558), not significantly different from that of the historical term cohort whose SBA GMT was 141 (95% C.I. 89, 224) (p=0.06). A significantly lower proportion of former preterm infants achieved a protective SBA titre of > or =8 compared with term infants, 37/48 (77%) versus 64/70 (91%), (p=0.03). For steroid-treated and non steroid-treated subgroups, SBA GMTs were 1237 (95% C.I. 250, 6132) and 154 (62, 385), respectively, and numbers achieving an SBA titre of > or =8 were 10/11 (91%) and 27/37 (73%), (p=0.42). Most children born at

Transient abnormal myelopoiesis (TAM), a preleukemic disorder unique to neonates with Down syndrome (DS), may transform to childhood acute myeloid leukemia (ML-DS). Acquired GATA1 mutations are present in both TAM and ML-DS. Current definitions of TAM specify neither the percentage of blasts nor the role of GATA1 mutation analysis. To define TAM, we prospectively analyzed clinical findings, blood counts and smears, and GATA1 mutation status in 200 DS neonates. All DS neonates had multiple blood count and smear abnormalities. Surprisingly, 195 of 200 (97.5%) had circulating blasts. GATA1 mutations were detected by Sanger sequencing/denaturing high performance liquid chromatography (Ss/DHPLC) in 17 of 200 (8.5%), all with blasts >10%. Furthermore low-abundance GATA1 mutant clones were detected by targeted next-generation resequencing (NGS) in 18 of 88 (20.4%; sensitivity ∼0.3%) DS neonates without Ss/DHPLC-detectable GATA1 mutations. No clinical or hematologic features distinguished these 18 neonates. We suggest the term "silent TAM" for neonates with DS with GATA1 mutations detectable only by NGS. To identify all babies at risk of ML-DS, we suggest GATA1 mutation and blood count and smear analyses should be performed in DS neonates. Ss/DPHLC can be used for initial screening, but where GATA1 mutations are undetectable by Ss/DHPLC, NGS-based methods can identify neonates with small GATA1 mutant clones.

De novo guidance on the management of Gram-negative bacteria outbreaks in UK neonatal units was developed in 2012 by a Department of Health, England Antimicrobial Resistance and Healthcare Associated Infection working group. The recommendations included activation of an organisational response and establishing a control team when an outbreak is suspected; screening for the specific organism only during an outbreak; undertaking multidisciplinary reviews of cleaning routines, hand hygiene and Gram-negative bacteria transmission risks; considering deep-cleaning; cohorting colonised and infected babies preferably but not necessarily in isolation cubicles; and considering reducing beds or closing a unit to new admissions as a way of improving spacing and staff:patient ratios until the outbreak is under control. The group advised establishing mechanisms to communicate effectively across the network; informing parents of the outbreak as early as possible, and providing prewritten 'infection outbreak' information sheets. For prevention of outbreaks, the group advised meeting national staffing and cot-spacing requirements; following a Water Action Plan; using infection reduction care bundles and benchmarking; and introducing breast milk early and limiting antibiotic use.

AimVancomycin is used as a second line antibiotic in the treatment of late onset neonatal infection for its activity against coagulase negative staphylococci. Vancomycin infusions are prepared within a ward setting for administration to neonates. Differences in preparation techniques on the ward have previously been recognised as a potential source of variation in vancomycin concentrations, as compared to concentrations in pre-made preparations. This study analyses a consecutive series of vancomycin syringes prepared in a ward for administration to neonates, to determine how accurate the concentration of each preparation was compared to the expected concentration.MethodVancomycin concentrations were determined by UV analysis (λ=280 nm) with a UV spectrophotometer (Jenway Genova Plus). A calibration curve for vancomycin was created (R2=0.9996) by manufacturing a series of solutions of vancomycin hydrochloride in glucose 5% w/v.Samples of vancomycin from syringes from which doses were administered to neonates were then analysed to assess their concentration. For each syringe, mean vancomycin concentration±standard deviation was calculated (n=3).Reasonable errors in preparations were calculated based on errors in each step of the preparation process. Theoretical error was calculated based on apparatus used, and experimental error was recorded based on a simulated process. Two preparation methods were compared; the method complying with that described in the local formulary, 1 and an alternative method reported by the nurses preparing the dose.ResultsAnalysis of results showed that concentration of the vancomycin syringes prepared ranged from 0.85 to 8.24 mg/mL. The expected concentration was 4.17 mg/ml.Theoretical error in preparation of vancomycin doses was lower with the formulary-compliant method1 versus an alternative method, as were variations in in vancomycin concentration.Depending on the type of error (theoretical or experimental) and method by which vancomycin syringes were prepared (formulary1 or alternative method), the percentage of syringes with vancomycin concentration outside of the specified ranges varied from 20%–43%. This is higher compared to the findings of the Department of Health2, where it was found that 19.2% of morphine infusions prepared by nurses in the neonatal intensive care unit were outside British Pharmacopoeia concentration limits.ConclusionPreparation of vancomycin doses should follow the formulary method1 to minimise variation in concentration of the final product. Alternatively, pre-made syringes may be preferred as an alternative to ward-made syringes as this removes individualised preparation as a source of error.

Recombinant human granulocyte (rhG) colony-stimulating factor (CSF) and recombinant human granulocyte-macrophage (rhGM) CSF have been used to enhance neonatal neutrophil host defense. We aimed to determine the comparative efficacy of rhG-CSF and rhGM-CSF in increasing numbers of granuloctye colony-forming unit (CFU-G) and granulocyte-macrophage colony-forming unit (CFU-GM) in recombinant human (rh) IL-3-dependent cultures of human neonatal circulating hematopoietic progenitor cells, including cells from infants born to hypertensive mothers. We also investigated the relationship between fractional increase in CFU-G and endogenous plasma concentraton of G-CSF. Circulating mononuclear cells were harvested from 25 neonates, and standard short-term assays in semisolid agar were established in the presence of rhIL-3 alone, rhIL-3 with rhG-CSF and rhGM-CSF, and both rhG-CSF and rhGM-CSF. CFU-G and CFU-GM were counted on d 14. Total colony number and CFU-G were significantly greater in cultures supplemented with rhG-CSF, with or without rhGM-CSF (p < 0.001 and p < 0.0005 for total colony number and CFU-G, respectively), when compared with cultures with rhIL-3 alone. Progenitor cells from three infants born to hypertensive mothers responded similarly. Total colony numbers and CFU-G were not increased by rhGM-CSF alone or by addition of rhGM-CSF to rhG-CSF; however, the proportions of CFU-GM were (p < 0.05 and p < 0.001, respectively, compared with rhIL-3 alone). Fractional increases in CFU-G with rhG-CSF were independent of plasma concentraton of G-CSF (r = 0.17; 95% confidence interval −0.5 to 0.19; p = 0.35). rhG-CSF was more efficacious than rhGM-CSF in enhancing CFU-G numbers in rhIL-3-dependent cultures, and plasma concentration of G-CSF did not predict response.

Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time.Prospective multicentre surveillance using a web-based database.12 English neonatal units.Newborns admitted in 2006-2008, with positive blood, cerebrospinal fluid or urine culture and treated with antibiotics for at least 5 days.Incidence, age at infection, pathogens and antibiotic resistance profiles.With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007-2008). The majority of infections occurred in premature (37 weeks) and low birthweight (2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS;48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS).The authors have established NeonIN in England and defined the current epidemiology of neonatal infections. These data can be used for benchmarking among units, international comparisons and as a platform for interventional studies.

Infant mortality is highest during the neonatal period. The provision of medical care for low birth weight and premature babies is challenging. Neonatal networks aim to improve outcome, optimize efficiency and increase the quality of care for these infants.

We present the longest known surviving case of a male infant with a mosaic complete trisomy 1q. Born at 39 weeks of gestation with respiratory distress, his weight was 3,330 g (25th centile); he had micrognathia, a posterior cleft of palate, abnormal ears and left thumb, syndactyly, and an absent corpus callosum. Initial blood karyotype was normal (46,XY). He died at age 5 months. Autopsy suggested aspiration as the primary cause of death and confirmed the antemortem findings of an absent corpus callosum and atrial septal defect. It also identified some central nervous system, cardiac, gastrointestinal, and lung anomalies not previously recognized. Cytogenetic analysis of skin fibroblasts obtained at autopsy showed a de novo unbalanced translocation between chromosomes 1 and 22: 46,XY,+1,der(1;22)(q10;q10)[25]/46,XY[65] in the cells examined. The previously reported cases had a similar phenotype with birth weight above the 50th centile for gestational age, small mouth, micrognathia, abnormal ears, abnormal fingers, microphthalmia, and hydrocephalus. The present case and a review of the literature delineates the phenotype in trisomy 1q, and reinforces the critical importance of effective communication between specialists, and obtaining permission for autopsy and skin biopsy, in the pursuit of a diagnosis.

Background: Group B streptococcus (GBS) is the most common cause of early onset (EO) neonatal infection in the UK. National guidelines for its prevention were introduced in 2003. We assessed the opportunities for prevention amongst cases of EO GBS using the electronic Neonatal Infection Surveillance Network (NeonIN). Methods: Culture proven EO GBS cases occurring between 2004 and 2007 were identified prospectively in eight neonatal units participating in NeonIN. Data concerning risk factors, intrapartum antibiotic (IAP) use and infant outcome were collected retrospectively. Results: There were 48 cases of GBS over the 4 years (0.52/1000 live-births); 22 male, median gestation 38 weeks. The most common clinical presentation was sepsis and the GBS-attributable mortality was 6%. Risk factors were present in 67% (32) and adequate IAP was given to six of these mothers (19%). If all women with risk factors received prophylaxis, 23 cases (48%) may have been prevented. Conclusions: Better GBS prevention strategies are required in the UK.

Summary Estimates of incidence of early-onset group B streptococcal (EOGBS) infection are based on blood or cerebrospinal fluid culture-proven cases, which can be falsely negative and hence underestimate the true burden of disease. Probable EOGBS infection can be defined as colonisation by group B streptococci accompanied by features of clinical sepsis. Data collected prospectively in the UK over 1 year for neonates who required a septic screen in the first 72 h of life indicated a combined rate of definite and probable EOGBS infection of 3·6 per 1000 livebirths. This estimate indicates a much greater disease burden in the UK than that suggested by figures of culture-proven sepsis, and lends support to the need for prevention strategies.

BACKGROUND Respiratory syncytial virus (RSV) specific immune globulin is now being marketed for prevention of RSV infection in ex-preterm infants. However, there are no published UK data on the morbidity or mortality from RSV in these infants. AIMS To determine the morbidity and mortality from RSV infection in a cohort of infants previously treated at a regional neonatal unit, and compare the cost of hospitalisation for RSV with the potential cost of administering RSV immune globulin (RSV-IG) prophylaxis. METHODS Infants born at a gestation of less than 32 weeks were studied. Details of admissions for respiratory illness in the first two years of life were collected from hospital records, referring hospitals, and general practitioners. RESULTS Data on 82 infants were collected. Up to three RSV seasons were encountered. The hospitalisation rate for confirmed RSV infection for the first season encountered was 4%. Rates of ward and paediatric intensive care unit admission were higher for infants with chronic lung disease. There were no deaths from RSV. RSV-IG would not have been cost effective for most infants. CONCLUSION The morbidity and mortality rates from RSV observed in this group do not support the widespread introduction of RSV-IG prophylaxis for ex-preterm infants.

Respiratory syncytial virus (RSV) affects almost all children in their first 2 years of life and can cause severe or even life-threatening disease in some at-risk infants. Treatment is limited and there is currently no safe or effective vaccine. However, a new monoclonal antibody, palivizumab, reduces RSV hospitalization by 55% in at-risk groups if given prophylactically throughout the RSV season.

We of Group B Strep Support (GBSS) were disappointed that Margaret McCartney reiterated some myths about screening for group B streptococcus during pregnancy.1 We challenge four of her statements. (1) “The risks of antibiotic use include anaphylaxis, which is thought to be fatal in one in 10 000 women treated.” This is an unreferenced statement from the UK National Screening Committee’s 2008 review of antenatal screening for streptococcus B. Fatal anaphylaxis is extremely rare. Law et al reported that 1.8 million women in the US were given benzylpenicillin (or ampicillin) between 1997 and 2001 with no deaths from anaphylaxis reported.2 Their review of UK data showed no adverse drug reactions attributable to benzylpenicillin in a population of 630 000 over six months. They conclude that the risk of death is negligible. (2) “Broad spectrum antibiotics lead to resistant organisms . . . The potential for long-term persistence of early-colonising bacteria suggests that much more thought should …

Tissue factor (TF) is known to be produced by monocytes from human peripheral blood. However the production of this factor by haematopoietic progenitor cells is not yet known. We thus studied human monocyte progenitor cells isolated from bone marrow of normal and diseased individuals. These cells were non-adherent, monocytic and able to phagocytose particles ranging from 0.3-1μm. Unactivated partial thromboplastin time clotting assay demonstrated procoagulant activity consistent with TF function, which was blocked by a neutralizing anti-TF monoclonal antibody, G12. The production of TF messenger RNA was demonstrated on dot blot and northern blot analysis utilizing an oligonucleotide probe.

Winter in the United Kingdom—wet, cold, miserable, and, yet again, the season for respiratory syncitial virus (RSV) bronchiolitis. About 3% of each year's birth cohort are admitted with bronchiolitis every winter in Europe, Australasia, and North America (20 000 infants in the UK, of whom 600 need ventilation1). Traditionally certain groups of infants are considered to be at high risk of developing more severe RSV bronchiolitis. These high risk groups include infants born prematurely (insufficient transfer of maternal RSV IgG) and those with chronic lung disease of prematurity, other underlying cardiorespiratory disease, or immunodeficiency. However the great majority of infants admitted are previously normal babies. The treatment of RSV bronchiolitis has had a chequered history, and, despite initial enthusiasm, it is now widely accepted that bronchodilators, steroids, and ribavirin have no overall significant benefit.2 This therapeutic nihilism makes paediatricians uneasy, and if we have no treatment, then surely prevention must be the answer. Pooled hyperimmune RSV intravenous immunoglobulin (RSV IVIG, Respigam) was licensed by the Food and Drug Admininstration in 1996 after …

In a pilot study recombinant human granulocyte colony-stimulating factor (rhG-CSF) was administered to 12 neutropenic preterm infants to determine if neonatal neutropenia is secondary to decreased endogenous G-CSF production. Respiratory variables were monitored because of the possible link between inflammatory cells and hyaline membrane disease. All infants showed increased neutrophil counts. The only possible side effect observed was an exacerbation of thrombocytopenia.

Preterm infants can acquire cytomegalovirus (CMV) from the breast milk of their CMV seropositive mothers. Postnatal CMV infection may be asymptomatic, but infants may develop pneumonitis, or sepsis syndrome. Hamprecht et al 1 recently studied the transmission of cytomegalovirus from CMV seropositive mothers to preterm infants who were exposed to maternal breast milk. Some 96% of seropositive breastfeeding mothers had selective re-activation of CMV in their breast milk with an incidence of acquired CMV infection in the neonatal unit of 22%. This rate of CMV acquisition in the neonatal unit appeared to be high in comparison with the experience of our own unit, which takes preventive measures against CMV. We therefore performed a prospective study from 1 July 1999 to …

Background: The outcome of neonatal septic neutropenia is poor. Methods Uncontrolled pilot study of rhG-CSF as adjuvant therapy in 12 neutropenic preterm infants (24-35 weeks gestation). All received appropriate antibiotics. Six infants recovered from acute, severe illness (4 with confirmed and 2 with probable sepsis). Four infants died from respiratory distress syndrome; 2 others were moribund pre-treatment and died after their first doses of rhG-CSF. Conclusions RhG-CSF may correct neutropenia; prophylactic use is likely to be of more benefit than interventional use; thrombocytopenia may be a side effect.

The in vitro effect of Granulocyte colony-stimulating factor on Interleukin-3-dependent proliferation of circulating haemopoietic progenitors in neonates