Streptococcus gallolyticus subspecies pasteurianus causing early onset neonatal sepsis complicated by solitary liver abscess in a preterm infant.

Streptococcus gallolyticus ssp pasteurianus (SGp) is an uncommon but increasingly recognized cause of neonatal sepsis and meningitis. Liver abscess in neonates is extremely rare. But liver abscess due to SG has never been reported in the literature. We present the first case of liver abscess due to SGp in a late preterm infant. A female infant was born at 36 weeks via normal vaginal delivery to a mother with unremarkable antenatal history. She had progressively worsening respiratory distress since birth and was intubated at 13 h of life. One dose of surfactant was delivered and ventilation continued. Parenteral crystalline Penicillin and Gentamicin were initiated and her blood culture at birth grew SGp. She had a spike of fever on day 5 of life. An ultrasound (US) scan of the abdomen was included in the septic work up. A multi-septated cystic liver abscess was noted in the right lobe of the liver. As there was inadequate response to appropriate intravenous antibiotics, needle aspiration and biopsy were performed on day 35 of life. Aspirate was sterile and histopathology confirmed a liver abscess. The patient continued to be treated with antibiotics for 8 weeks with serial US scans of the liver showing resolution of the abscess. Increasing awareness among paediatric and neonatal fraternity about these new emerging bacterial infections can facilitate early diagnosis and treatment.

New BPD-prevalence and risk factors for bronchopulmonary dysplasia/mortality in extremely low gestational age infants ≤28 weeks.

OBJECTIVE: To evaluate prevalence and risk factors of moderate-severe Bronchopulmonary dysplasia (BPD)/Death in extremely low gestation age neonates (ELGANs). STUDY DESIGN: Study of 266 ELGANs born at gestational age (GA) ≤ 28 weeks (w). Primary Outcome measure-composite outcome of moderate-severe BPD/Death using the National Institute of Child Health and Human Development NICHD's (2001) BPD definition. RESULT: Cohort's mean GA and birth-weight (BW) were 25.3 ± 1.4w and 724 ± 14 g respectively with an overall mortality of 19% and moderate-severe BPD of 67%. Prevalence of moderate-severe BPD/death decreased significantly with increasing GA (86-93%) at 23-24 w; to <60% at 27-28w (OR 0.63; 95% CI; 0.52-0.77). On univariate analysis, other risk factors included BW(OR 1.005; 95% CI; 1.003-1.007), Sepsis (OR 2.9; 95% CI, 1.3-6.4), PDA needing treatment (OR 2.2; 95% CI, 1.3-3.9); air leaks (OR 2.7; 95% CI; 1.02-7.3) FiO2 requirement >25%(OR 1.06; 95% CI; 1.01-1.11); and mechanical ventilation(MV) on Day7 (OR5.5; 95% CI; 2.8-10.8). Only need for Day7 MV was independently predictive of composite outcome (OR1.97; 95% CI; 1.3-3.1). CONCLUSION: Risk factor identification will enable initiatives to implement lung protective strategies and develop prospective models for BPD prediction and prognostication.