ABSTRACT
Objective To discuss the controversial role of breast milk in late-onset group B Streptococcus (GBS) infections.Methods This study reported a case of recurrent late-onset GBS sepsis with the suspicion of breast milk transmission in an extremely preterm infant born at 22+6 weeks who was treated at the University of Hong Kong-Shenzhen Hospital in September 2016.Literatures about late-onset GBS cases associated with contaminated breast milk were reviewed to investigate whether GBS could be transmitted through breast milk.Results (1) Case report:A breast-fed extremely preterm infant born at 22+6 gestational weeks suffered from GBS sepsis along with meningitis for the first time on 100 d.The mother was negative for rectovaginal GBS screening.Breast milk wasn't tested as no signs of mastitis were found.The neonate recovered from the first GBS sepsis after 14 days of antibiotic treatment,then returned to breastfeeding.On 126 d,GBS sepsis reoccurred in this baby.Fresh breast milk culture yielded GBS which was identical with the GBS strains isolated from the neonatal blood in antimicrobial susceptibility.After recovery from the second episode,the baby was partially breastfed again without further relapses of late-onset GBS sepsis.(2) Literature review:64 cases of late-onset GBS infections that transmitted via breast milk were retrieved from PubMed,while no Chinese cases had been reported.Clinical data of the 65 cases (including this case) were reviewed and the results revealed that contaminated breast milk was associated with late-onset GBS infections.The reported relapse rate of GBS infections transmitted via breast milk was 25％ for two episodes and 7％ for three episodes.Conclusions GBS contaminated breast milk could potentially cause late-onset GBS sepsis in infants and further studies are required to identify the underlying mechanisms.
ABSTRACT
Objective To study the influence of optimization of parenteral nutrition strategy on the head circumference and brain volume in very low birth weight infants.Method Very low birth weight infants admitted to NICU of University of Hong Kong-Shen Zhen Hospital from January 2014 to June 2016 were assigned to optimized group and conventional group according to early nutritional strategies.Early parenteral nutrition intakes were increased in infants assigned to optimizated group.Nutrition intakes and parenteral nutrition related complications within 28 days after birth were compared between groups.All participants underwent brain MRI at corrected gestational age (CGA) 36 weeks.Head circumference and brain volume measured by MRI were also compared between groups.Result A total of 40 preterm infants were recruited,with 20 infants in each group.There were no significant differences in the gestational age,birth weight,brain injury and intrauterine growth retardation rate between the two groups (P ＞ 0.05).The average daily total calories and protein intake of optimization group during the first 4 weeks were significantly higher than those of conventional group,respectively [(101.5 ± 3.1) kcal/ (kg · d) vs.(96.1 ± 3.2)kcal/(kg·d),(3.07±0.16) g/(kg·d) vs.(2.90±0.11) g/(kg· d),P＜ 0.05].Theaverage daily calorie intake and protein intake of optimization group was increased by 4.7％ and 5.5％,compared with those of conventional group.Compared with the conventional group,head circumference and total brain volume of optimized group at CGA 36 weeks was improved by 3.3％ and 4.1％,and the differences were both statistically significant (P ＜ 0.05).Cerebral cortex gray matter volume of optimized group was significantly higher than that of conventional group [(102.4 ± 4.9) ml vs.(96.4 ± 4.6) ml,P ＜ 0.05].There was no significant difference in brain white matter,deep gray matter and cerebrospinal fluid volume between the two groups (P ＞ 0.05).Conclusion The optimization of parenteral nutrition within the framework of active nutrition strategy of preterm infants can further improve the early nutritional intake of preterm infants,leading to the increase of the head circumference and the gray matter volume of the cerebral cortex.