[Successful continuous renal replacement therapy in a neonate with early-onset group B streptococcal sepsis and multi-organ dysfunction syndrome].
BACKGROUND
Group B streptococcal early-onset sepsis (GBS EOS) in neonates has a mortality rate of approximately 5%, particularly in the presence of multi-organ dysfunction. Fluid management is crucial in these patients, and continuous venovenous haemofiltration (CVVH) should be considered a therapeutic option even in newborn babies.


METHODS
After an uneventful pregnancy within hours after birth, a female term infant presented with dyspnoea, irritability and cyanosis. The systemic inflammatory response syndrome (SIRS) progressed to multi-organ dysfunction with acute respiratory distress syndrome (ARDS), impaired myocardial contractility, pulmonary hypertension and fluid overload. The maximum PRISM score was 51. The child required maximal respiratory and inotropic support with high volume intravenous fluid administration. However, only by using of CVVH from day 5 to 14, we successfully resolved progressive pulmonary and cardiovascular dysfunction. The child improved directly after initiation of fluid removal, was extubated on day 17 and discharged without obvious sequelae on day 57. All microbiology studies revealed GBS.


CONCLUSIONS
Perinatal GBS-infections remain a major life-threatening event for newborn babies. CVVH should be considered an option for reversing fluid overload even in neonates with overwhelming SIRS. Alternatively, extracorporeal membrane oxygenation (ECMO) is discussed.
von Schnakenburg
C
C
Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Germany. christian.schnakenburg@uniklinik-freiburg.de
Hufnagel
M
M
Superti-Furga
A
A
Rieger-Fackeldey
E
E
Berner
R
R
D005260:Female; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000628:therapy*; D013292:Streptococcus agalactiae; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000628:therapy*