Dear Members,

We have treated a 25 days old baby born at 34 weeks of gestational age for a devastating late onset GBS meningitis.

Her sister (monochorial twin) is colonized by GBS and swabs are still positive to streptococcus after 2 weeks of treatment with amoxicillin and probiotics. We also treated parents with same drugs.

The healthy sister, of course, is very well, but parents (and we too) are very worried.

Please, could anyone give a suggestion about a correct management of the baby?

Many Thanks

Marcello De Filippo

Neonatal subintensive care unit

Grosseto Hospital - Italy

There is no evidence that treating GBS colonisation would reduce the risk of late-onset disease; even intra-partum prophylaxis has little effect on the late-onset disease. The approproate management for the twin sister would be early institution of Penicillin if she shows any signs of illness but otherwise nothing else is needed.

Dr Sanjeev Deshpande

Consultant Neonatologist

Shrewsbury, UK.

Marello: I would agree with Dr. Deshpande. It is understandable that a serious infection like meningitis in the first twin would worry any of us regarding the risks to the other twin. One might worry if this is a particularly virulent strain of GBS or could the twins both of some immunodeficiency making them more susceptible to infection. However, the most likely scenario is that the first twin, being premature and colonized, was unlucky enough to become infected (most likely through the usual portals). If the other twin is asymptomatic the acceptable approach would be to watch her closely at home. Perhaps a thorough discussion with the family regarding what to watch for would be the most beneficial, and then work up and treat if she shows any signs or symptoms of possible infection. Good luck.

Les Lang

Neonatologist

USA

My input in this scenario is to monitor closely the asymptomatic twin and early treatment with either penicillin or ampicillin. However I would recommend to culture breast milk to look for GBS and if found positive consider discontinue breastfeeding. This will reduce exposure to GBS.