Infant Journal
for neonatal and paediatric healthcare professionals

Necrotising enterocolitis in a preterm infant with late-onset group B streptococcus sepsis and meningitis

Here we report the case of a preterm infant born at 29+5 weeks’ gestation who presented at two weeks of age with symptoms of necrotising enterocolitis (NEC) and features of late-onset sepsis. NEC was diagnosed radiologically and group B streptococcus (GBS) was isolated in blood and cerebrospinal fluid cultures. The baby was treated medically for NEC, sepsis and meningitis and later suffered significant complications of meningitis with hydrocephalus. This case report describes the link between late-onset GBS sepsis and NEC.

Dyanne Imo-Ivoke
ST2 Paediatrics
Hull University Teaching Hospitals NHS Trust

Joanna M Preece
Consultant Neonatologist, Department of Neonatology, University Hospitals of Leicester

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group B streptococcus; necrotising enterocolitis; late-onset sepsis; meningitis; preterm neonate
Key points
  1. NEC may be caused by GBS but NEC remains a poorly understood condition and no assumptions should be made regarding its causative factors.
  2. In preterm infants colonised with GBS and at risk of NEC, NEC may be the primary trigger of blood sepsis and associated severe complications such as meningitis.
  3. In a patient with GBS-associated meningitis, it is relevant to institute cranial monitoring.

Also published in Infant:

Coffee bean sign in a preterm neonate on an abdominal X-ray
A preterm male infant presented with abdominal distension and palpable bowel loops at 27 days of life. An abdominal X-ray showed a ‘coffee bean’ appearance of the bowel and raised the possibility of a sigmoid volvulus. Subsequent abdominal X-rays showed resolution of the coffee bean but the presence of intramural gas, and thus the infant was managed conservatively for necrotising enterocolitis. In this case a careful clinical evaluation with early imaging and multidisciplinary team discussion played an important role in ruling out sigmoid volvulus.