Sepsis Could be Underestimated in New-Born Babies (p 1953)

UK authors of a research letter in this week's issue of THE LANCET suggest that the incidence of disease caused by group B streptococcal infection in babies is underestimated because the 'gold standard' methods for bacterial detection may result in falsely negative results.

Around one in 1000 babies experience a serious immune response (sepsis) to a type of bacterial infection called early-onset group B streptococcal (EOGBS) infection. However, the incidence of EOGBS sepsis could be underestimated as
the conventional diagnostic tests (blood or cerebrospinal fluid assessment) often result in false-negative results. Benzylpenicillin (a narrow-spectrum antibiotic) is the most appropriate treatment for neonatal sepsis.

Alison Bedford-Russell and colleagues from St Georges Hospital, London, UK, assessed the incidence of sepsis over one year in around 400 babies referred for sepsis screening within three days after birth. "Confirmed" early onset
infection was diagnosed if a baby was younger than three days, had a positive blood or cerebrospinal culture for group B streptococcus, and had symptoms of sepsis, pneumonia, or meningitis. "Probable" infection was diagnosed if a baby had a positive deep-ear swab for group B streptococcus accompanied by clinical pneumonia, meningitis, or sepsis. The combined rateof definite and probable EOGBS infection was 3.6 per 1000 livebirths.

Alison Bedford-Russell comments: "The results of this prospective study confirm our previous finding that relying on blood or cerebrospinal cultures alone to assess the incidence of EOGBS sepsis results in underestimation of the true burden of this disease in neonates...The outcome of UK health economic analyses needs to be known before prevention policies for EOGBS are available in this country, and cases of probable sepsis should be included in such an analysis. We suggest that in the meantime there should be active surveillance of both definite and probable EOGBS infection in every maternity unit, to plan and implement appropriate local prevention guidelines."

Contact: Dr Alison R Bedford Russell MRCP, Neonatal Unit, Chelsea and Westminster Healthcare NHS Trust, 369 Fulham Road, London SW10 9NH, UK; T) +44 (0)20 8846 7975 (office) 7881 (secretary); F) +44 (0)20 8846 7998; E) alison.russell@chelwest.nhs.uk

From: THE LANCET.