This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (20) Citing Articles via Google Scholar Google Scholar Articles by Hoffman, J. A. Articles by Kaplan, S. L. Search for Related Content PubMed PubMed Citation Articles by Hoffman, J. A. Articles by Kaplan, S. L. Related Collections Premature & Newborn Related AAP Red Book topics: Non-Group A or B Streptococcal and... Pneumococcal Infections Social Bookmarking                         What's this?

PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1095-1102

Streptococcus pneumoniae Infections in the Neonate

Jill A. Hoffman, MD^*, Edward O. Mason, PhD, Gordon E. Schutze, MD, Tina Q. Tan, MD^||, William J. Barson, MD^¶, Laurence B. Givner, MD^#, Ellen R. Wald, MD^**, John S. Bradley, MD, Ram Yogev, MD^||, Sheldon L. Kaplan, MD

^* Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
^|| Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois
^¶ Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio
^# Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
^** Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Division of Infectious Diseases, Children’s Hospital-San Diego, San Diego, California

Objective. Streptococcus pneumoniae infections in the neonate (SPIN) are relatively unusual events (1%–11% of neonatal sepsis) but are associated with substantial morbidity and mortality. Previous reports suggest that invasive SPIN is associated with prolonged rupture of membranes, maternal colonization/illness, prematurity, early-onset pneumonia presentation (<72 hours), and high mortality (50%). The aim of this study was to review the current epidemiology and clinical course of SPIN.

Methods. The US Pediatric Multicenter Pneumococcal Surveillance Group has been prospectively monitoring S pneumoniae infections since 1993 in 8 children’s hospitals. For this report, data were gathered retrospectively from the charts of neonates who were 30 days of age and younger and had SPIN from September 1993 to February 2001. All pneumococcal isolates were sent to a central laboratory for serogrouping/typing and susceptibility testing.

Results. Twenty-nine cases of SPIN were identified from a total of 4428 episodes of S pneumoniae infection in children. Sixty-six percent were male, and 55% were white; the mean age was 18.1 day (±8.2). Ninety percent of infants were 38 weeks’ gestation. Two mothers had bacterial infections at delivery; 1 had S pneumoniae isolated from both blood and cervix, and 1 had clinical amnionitis. The primary diagnoses in the neonates were bacteremia (8), meningitis (8), bacteremic pneumonia (4), septic arthritis/osteomyelitis (1), and otitis media (8). Thirty percent of infants with invasive SPIN presented with leukopenia/neutropenia, but this did not predict poor outcome. The infecting pneumococcal serogroups were 19 (32%); 9 (18%); 3 and 18 (11% each); 1, 6, and 14 (7% each); and 5 and 12 (3.5% each). Twenty-six percent of invasive neonatal infections were caused by serogroups 1, 3, 5, and 12, which are not contained in the heptavalent pneumococcal vaccine. In contrast, 6% of invasive nonneonatal disease was caused by these same nonvaccine serogroups. Susceptibility testing demonstrated that 21.4% of isolates were penicillin nonsusceptible and 3.6% were ceftriaxone nonsusceptible. Three (14.3%) neonates with invasive SPIN died; all deaths occurred within 36 hours of presentation. Deaths did not appear to be related to pneumococcal serogroup or susceptibilities.

Conclusions. Compared with previous studies of neonates with pneumococcal infection, this series showed that infants with SPIN were usually 2 to 3 weeks of age at presentation; likely to be full term; and ill with pneumonia, meningitis, and otitis media. This late-onset presentation was associated with an overall mortality rate of 10.3% (14.3% for invasive disease).

---

Key Words: Streptococcus pneumoniae • neonates • risk factors

Abbreviations: PCV7, heptavalent pneumococcal conjugate vaccine • SPIN, Streptococcus pneumoniae infections in the neonate • GBS, group B Streptococcus • PROM, prolonged rupture of membranes • GA, gestational age • LBW, low birth weight • S, susceptible • I, intermediate • R, resistant • OM, otitis media • SD, standard deviation • DOL, day of life • WBC, white blood cell

---

Received for publication Oct 17, 2002; Accepted Feb 21, 2003.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. S. Huang, S. L. Rifas-Shiman, K. Kleinman, J. Kotch, N. Schiff, C. J. Stille, R. Steingard, and J. A. Finkelstein Parental Knowledge About Antibiotic Use: Results of a Cluster-Randomized, Multicommunity Intervention Pediatrics, April 1, 2007; 119(4): 698 - 706. [Abstract] [Full Text] [PDF]

				B. E. Mahon, V. Ehrenstein, M. Norgaard, L. Pedersen, K. J. Rothman, and H. T. Sorensen Perinatal Risk Factors for Hospitalization for Pneumococcal Disease in Childhood: A Population-Based Cohort Study Pediatrics, April 1, 2007; 119(4): e804 - e812. [Abstract] [Full Text] [PDF]

				L. H. Rose and J. Guzman-Cottrill Index of Suspicion in the Nursery NeoReviews, October 1, 2006; 7(10): e546 - e548. [Full Text] [PDF]

				K. A. Poehling, T. R. Talbot, M. R. Griffin, A. S. Craig, C. G. Whitney, E. Zell, C. A. Lexau, A. R. Thomas, L. H. Harrison, A. L. Reingold, et al. Invasive Pneumococcal Disease Among Infants Before and After Introduction of Pneumococcal Conjugate Vaccine JAMA, April 12, 2006; 295(14): 1668 - 1674. [Abstract] [Full Text] [PDF]

				R. Pai, R. E. Gertz, and B. Beall Sequential Multiplex PCR Approach for Determining Capsular Serotypes of Streptococcus pneumoniae Isolates J. Clin. Microbiol., January 1, 2006; 44(1): 124 - 131. [Abstract] [Full Text] [PDF]

				T Duke Neonatal pneumonia in developing countries Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2005; 90(3): F211 - f219. [Abstract] [Full Text] [PDF]

				E. G. Shepherd, Q. Zhao, S. E. Welty, T. N. Hansen, C. V. Smith, and Y. Liu The Function of Mitogen-activated Protein Kinase Phosphatase-1 in Peptidoglycan-stimulated Macrophages J. Biol. Chem., December 24, 2004; 279(52): 54023 - 54031. [Abstract] [Full Text] [PDF]