prevalence of group B streptococcus colonization in Iranian pregnant women and its subsequent outcome

Group B streptococcus colonization in pregnant women usually has no symptoms, but it is one of the major factors of newborn infection in developed countries. In Iran, there is a little information about the prevalence of maternal colonization and newborns infected by group B streptococcus. In order to find the necessary information to create a protocol for prevention and treatment of group B streptococcus infection in newborns, we conducted a study of its prevalence among Iranian pregnant women and its vertical transmission to their newborns. This is a cross-sectional descriptive and analytic study performed at Prenatal Care Clinic of the Sarem Hospital from 2009 to 2011. The pregnant women with the gestational age of 35-37 weeks were enrolled in the study. The vaginal culture for group B streptococcus was done for 980 mothers based on our protocol. Among 980 mothers, 48 were shown positive vaginal culture; however, 8 cases among these 48 mothers were positive for both vaginal and urine culture. Babies with mothers showing positive vaginal culture were screened for infection using complete blood count /blood culture [B/C] and C-reactive protein [CRP]. Then, a complete sepsis workup was performed for babies with any signs of infection in the first 48 hours after birth, and they received antibiotic therapy if necessary. All collected data were analyzed [SPSS version 15]. Among 980 pregnant women with vaginal culture, 48 cases had positive group B streptococcus cultures among which 8 mothers also had positive group B streptococcus urine culture. Our findings revealed that 22 [50%] symptomatic neonates were born from the mothers with positive vaginal culture for group B streptococcus. About 28 of them [63%] had absolute neutrophil count more than normal, and 4 [9.1%] newborns were omitted from the study. Therefore, 50% of neonates showed clinical feature, whereas para-clinical test was required to detect the infection for the rest of neonates who showed no signs or symptoms. The colonization of group B streptococcus in Iranian women is significant, while 50% of newborns from mother with positive vaginal culture were symptomatic after birth; therefore, screening of newborns for group B streptococcus infection is recommended to become a routine practice in all healthcare centers in Iran

Neonatal atypical hemolytic uremic syndrome may cause prenatal asphyxia

Microthrombi formation and hemolytic anemia are signs of hemolytic-uremic syndrome [HUS] that result from platelet consumption and red blood cell [RBC] destruction due to vascular damage. HUS manifests as a triad of signs: micro-angiopathic hemolytic anemia, thrombocytopenia, and uremia. Prenatal asphyxia [PA] also leads to renal insufficiency and vascular damage. There is an overlap between the clinical presentation of PA and neonatal atypical HUS. We have reported the case of a neonate with a primary diagnosis of PA and clinical presentation of acute renal failure [ARF], anemia [Hb = 10 g/dl] and thrombocytopenia [Plt = 80000]. His APGAR scores were 1 [1 minute], 3 [5 minutes], and 7 [10 minutes]. A peripheral blood smear [PBS] was performed, which contained schistocytes [32%] with helmet and burr cells. The neonate's cord blood gas values were: pH of 7.07, HCO[3] = 11mmol/L, and CO[2] = 57mmHg. The first two days of life, he was anuric with elevated BUN and Cr [2.1mg/dL] levels. Complement [C3] was within normal limits at 0.65 g/L [0.89-1.87 g/L], however C4 was below the lower limit of normal at 0.14 g/L [0.16-0.38 g/L]. We ruled out other causes of PA such as maternal illness, placenta abnormalities and infections [TORCH]. We hypothesized that atypical neonatal HUS can progress to PA because of the presence of severe anemia and microthrombi formation