Neonatal group B streptococcal disease associated with infected breast milk

William J Olver; David W Bond; Tim C Boswell; Sara L Watkin

doi:10.1136/fn.83.1.F48

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Neonatal group B streptococcal disease associated with infected breast milk

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GBS in breast milk with neonatal meningitis and serious consequences for pituitary function
Anjum Deorukhkar
Published on: 9 January 2022
Should we be proactive in reducing exposure of neonates to infected breast milk?
J McAloon
Published on: 9 January 2022

Published on: 9 January 2022
GBS in breast milk with neonatal meningitis and serious consequences for pituitary function
- Anjum Deorukhkar, Specialist Registrar
Dear Editor:
We read with interest the paper by Olver et al[1] describing triplets with group B streptococcal (GBS) infections acquired from breast milk. We have recently seen a case of GBS meningitis in a 34 week gestation infant and suspect that the source of infection was the maternal breast milk.
At delivery there were no risk factors for sepsis. In particular, the baby was delivered by elective Caes...
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Dear Editor:
We read with interest the paper by Olver et al[1] describing triplets with group B streptococcal (GBS) infections acquired from breast milk. We have recently seen a case of GBS meningitis in a 34 week gestation infant and suspect that the source of infection was the maternal breast milk.
At delivery there were no risk factors for sepsis. In particular, the baby was delivered by elective Caesarian section for growth retardation, without any prior rupture of membranes. No organisms were grown from routine admission blood culture and surface swabs. During the first week of life, our infant remained asymptomatic. The white cell count and C reactive protein levels remained within the normal range. On day 7, a full septic screen was performed for recurrent bradycardias. The white cell count was 3.9 x 10⁹/l (neutrophils 0.3 x 10⁹/l) and the C reactive protein was less than 7mg/l. GBS (serotype III) was isolated from both the blood and CSF cultures. The C reactive protein started to rise after twelve hours, and reached a peak of 353mg/l. As the source of the infection was not clear, a sample of maternal breast milk was cultured and the same serotype of GBS was isolated. There was no clinical evidence of mastitis.
Following the development of meningitis, cranial ultrasonography demonstrated periventricular vasculitis and increased echogenicity of the caudothalamic nucleus. No haemorrhagic lesions or structural abnormalities were detected either before or after the onset of this illness. On day 12 our infant became polyuric with dilute urine (osmolarity 70mOsm/kg) in the face of a high serum osmolarity (314mOsm/kg). A diagnosis of diabetes insipidus was therefore made and treatment with ddAVP was commenced. Subsequent investigations revealed evidence of hypopituitarism requiring replacement therapy. Cortisol was undetectable. Free thyroxine was low with a TSH level of 3.52mIU/l.
We agree that GBS transmission in breast milk may have been underestimated as a cause of late-onset sepsis and agree that breast milk should be screened in all such cases. Larger studies would be required to determine the true incidence of the problem. This case also underlines the need to actively look for the known-but-uncommon complications following neonatal meningitis such as diabetes insipidus and hypopituitarism.[2]
Anjum Deorukhkar
Robin Miralles
Jessop Hospital for Women
Sheffield, South Yorkshire, UK
References
(1) Olver WJ, Bond DW, Boswell TC, Watkin SL. Neonatal group B streptococcal disease associated with infected breast milk. Arch Dis Child Fetal Neonatal Ed 2000;83:F48-9.
(2) Cohen C, Rice EN, Thomas DE, Carpenter TO. Diabetes insipidus as a hallmark neuroendocrine complication of neonatal meningitis. Current Opinion in Pediatrics 1998;10:449-52.
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Conflict of Interest:
None declared.
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Published on: 9 January 2022
Should we be proactive in reducing exposure of neonates to infected breast milk?
- J McAloon, Consultant Paediatricians
- Other Contributors:
  JG Jenkins
Dear Editor
Reports of microbial contamination of expressed unpasturised breast milk (EBM)[1-3] are not new but the paper from Olver et al[4] again highlights that this routine aspect of neonatal care has the potential to provide a source for bacterial infection in immature neonates.
Culture or pasturisation of a mother's own non-banked milk is not however routine practice in neonatal units in the UK and may even b...
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Dear Editor
Reports of microbial contamination of expressed unpasturised breast milk (EBM)[1-3] are not new but the paper from Olver et al[4] again highlights that this routine aspect of neonatal care has the potential to provide a source for bacterial infection in immature neonates.
Culture or pasturisation of a mother's own non-banked milk is not however routine practice in neonatal units in the UK and may even be considered as "breastfeeding unfriendly" if associated processing delays result in breast milk substitutes being administered to babies. Unfortunately there is an absence of controlled trials examining what constitutes significant contamination and addressing the appropriateness or otherwise of bacteriological screening of unbanked EBM to assist units in formulating an informed approach.
Our neonatal unit's policy of culturing expressed milk prior to feeding it to sick preterm infants, reflecting concern raised through case reports, has been controversial particularly among midwifery staff and is currently under review. Olver et al's triplets[4] have been timely for us in this regard and we are interested to learn of other units' policies and practice.
Dr J McAloon
Dr J G Jenkins
NICU, Antrim Hospital
45 Bush Road
Antrim BT41 2LL, UK
References
(1) Davidson DC, Poll RA, Roberts C. Bacteriological monitoring of untreated human milk. Arch Dis Child 1979;54:760-4.
(2) Eidelman IA, Szilagyi G. Patterns of bacterial colonization of human milk. Obstet Gynecol 1979;53:550-2.
(3) Ng PC, Lewindon PJ, Siu YK, Wong W, Cheung KL, Liu K. Bacterial contaminated breast milk and necrotizing enterocolitis in preterm twins. J Hosp Infect 1995;31:105-10.
(4) Olver WJ, Bond DW, Boswell TC, Watkin SL. Neonatal group B streptoccal disease associated with infected breast milk. Arch Dis Child Fetal Neonatal Ed 2000;83:F48-9.
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Conflict of Interest:
None declared.
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