A. Stepišnik
Otroški oddelek, Splošna bolnišnica Izola, Izola, Slovenija

I. Cetin Lovšin
Otroški oddelek, Splošna bolnišnica Izola, Izola, Slovenija

B. Živin Filipič
Otroški oddelek, Splošna bolnišnica Izola, Izola, Slovenija

I. Smajla
Otroški oddelek, Splošna bolnišnica Izola, Izola, Slovenija

T. Priman
Otroški oddelek, Splošna bolnišnica Izola, Izola, Slovenija

Abstract

Background: Group B Streptococcus (GBS) is the leading cause of neonatal sepsis in developed countries. Only a few cases of late-onset neonatal sepsis in twins are described in the literature, most often in premature babies. The origin of late-onset infection is not entirely clear, although recent reports strongly suggest an enteral mode of transmission from infected breast milk. Patients and methods: We present a case of dizygotic male twins, (gestational age 35 weeks; birth weights: 2070 g and 2050 g), who were born after induction of vaginal labour due to maternal hepatopathy in a 28-year old primigravida. Antenatal vaginal swabs were not taken and she did not receive any peripartum antibiotic. An external ear canal swab taken from twin B grew GBS, otherwise, the postnatal period of both was completely uneventful. On the thirteenth day after birth, twin A vomited once and refused further feedings. During the night, he became febrile (39°C) and was brought to our hospital in the morning. On admission, he was hypotonic, hypoglycaemic and poorly responsive, with prolonged capillary refill. Intensive therapy with boluses of fluid, glucose solutions, antibiotic therapy, bicarbonate, vasopressor infusion and artificial ventilation slightly improved his condition. Later, short episodes of bradycardia occurred, which were responsive to brief reanimation. He was transported to the intensive care unit, where he died a few hours after arrival, after prolonged reanimation. Blood cultures (BC) grew GBS. The same day his brother, twin B, was admitted for preventive parenteral antibiotic treatment. On admission, he was clinically without difficulties, but with a slightly poorer weight gain. Parameters of infection were low. BC were taken and were also GBS positive. The same pathogen was also isolated from the breast milk. With penicillin treatment, his weight gain markedly improved and, with treatment, both the boy’s and his mother’s microbiological cultures became sterile. Conclusion: Late-onset neonatal sepsis is a life-threatening condition. As the pathogenesis of the disease is not fully understood, there are no effective preventive strategies. Prematurity is an important risk factor, hence special warning should be given to the parents of premature babies before discharge from hospital. In rare cases of GBS sepsis in one twin, the other should be promptly evaluated for possible infection.

Key words: neonate, infection, intensive treatment.