Group B streptococcal infection in the perinatal period. An increasing problem in newborn care

Group B streptococcal infections in newborn infants are increasing in frequency. Infection takes two forms--early-onset, developing in the first 24 hours, and late-onset, developing after the first week. Early-onset disease, a fulminating septicaemia, has a mortality of 40-70%. Late-onset disease, usually meningitis, has a mortality of 20-30%, with a high incidence of neurological damage in survivors. Early-onset disease is acquired during delivery from organisms colonizing the vagina. Up to 25% of women are colonized in late pregnancy. So far, no effective programmes for prevention have been developed.

Increased frequency of neonatal jaundice in a maternity hospital

The frequency of "significant" jaundice of the newborn at this hospital increased from 8-1% of all live births in 1971 to 12-1% in 1972 and 15-4% in 1973. This coincided with an increased use of oxytocic agents and epidural anaesthetics in labour, and a change in the artificial feed given to normal infants. A retrospective study of jaundiced infants born in 1972 failed to explain the increase in jaundice. Though the use of oxytocic agents was not the direct cause, since their use results in the delivery of more infants before 40 weeks of gestation it may be a contributory factor. The use of epidural anaesthetics was sastically related to the development of jaundice but the nature of the association was not clear. Mothers of infants who became jaundiced has a significantly higher frequency of poor past obstetric histories, but once again the association was not clear. The change in artificial feeds was excluded as a possible cause.

Defibrination syndrome with defective thrombinfibrinogen reaction reversible by protamine

A patient with the obstetric defibrination syndrome successfully treated with human fibrinogen is described. The blood not only contained low levels of fibrinogen capable of clotting but also contained an inhibitor of the thrombin-fibrinogen reaction. This was neutralized in vitro with protamine but it was not heparin. Neither abnormality was detected by a latex agglutination test for plasma fibrinogen. The use of this test does not therefore exclude the diagnosis of the defibrination syndrome.