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Non-Group A or B Streptococcal and...
Pneumococcal Infections
PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1095-1102

Streptococcus pneumoniae Infections in the Neonate

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

* Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
{ddagger} 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
{ddagger}{ddagger} 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.




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