ABSTRACT
BACKGROUND: Group B Streptococcus (GBS) is a well-known cause of neonatal pneumonia, sepsis and meningitis. Peripartal antibiotic prophylaxis for early-onset GBS infection is in routine use since the beginning of the last decade, but strategies for effective prevention of late-onset GBS infections are still lacking. CASE REPORT: Few hours after discharge from a non-local maternity ward a 3-week-old boy was admitted to our hospital because of GBS meningitis with necrotizing encephalomalacia. Maternal mastitis, not a disease of the baby, had led to the first admission. DISCUSSION: Case history and negative maternal swabs and cultures for GBS led to the hypothesis of nosocomial infection. Screening and risk based peripartal antibiotic prophylaxis, better monitoring and improved therapeutic modalities have reduced the incidence and mortality of early-onset GBS infections, but peripartal prophylaxis failed to influence late-onset GBS infections. Up to 40 % of infants with late-onset meningitis develop neurological sequelae. Maternal vaccination with multivalent conjugate vaccines against GBS is a new strategy which may lead to passive protection of the infant. Further studies to examine the efficacy of vaccines are in progress.
Subject(s)
Cross Infection/diagnosis , Encephalomalacia/diagnosis , Meningitis, Bacterial/diagnosis , Streptococcal Infections/diagnosis , Streptococcus agalactiae , Anti-Bacterial Agents , Brain/pathology , Brain Edema/diagnosis , Cross Infection/drug therapy , Cysts/diagnosis , Drug Therapy, Combination/therapeutic use , Echoencephalography , Encephalomalacia/drug therapy , Follow-Up Studies , Frontal Lobe/pathology , Humans , Infant, Newborn , Magnetic Resonance Imaging , Male , Meningitis, Bacterial/drug therapy , Microbial Sensitivity Tests , Streptococcal Infections/drug therapyABSTRACT
OBJECTIVE: The objective of this article is to describe a case of acute subdural hematoma in an infant after difficult delivery and to describe the literature regarding therapy and outcomes of these patients. DESIGN: Case report. PATIENT: Critically ill male newborn who suffered from acute subdural hematoma after a difficult caesarean section. RESULTS: A craniotomy and evacuation of the acute subdural hematoma was performed. At discharge and 2 months after birth, the infant presented without any signs of neurologic sequelae, but further neurologic and developmental follow-up studies remain necessary. CONCLUSION: Acute subdural hematoma is a rare but severe intracranial complication of obstetric trauma. The early recognition of this complication and immediate surgical intervention could possibly prevent later neurologic sequelae.
