[Listeriosis in the newborn infant: improved prognosis due to early detection]

Abstract

Perinatal clinical data were collected retrospectively from 35 newborn infants infected with Listeria monocytogenes and compared with the subsequent outcome. The average annual incidence of neonatal listeriosis in the Canton of Zurich (Switzerland) between 1983 and 1987 was 0.33 per 1000, which is more than twice that during the preceding 10 years. This increase paralleled a similar outbreak in the French part of Switzerland, where contaminated soft cheese was found to be the source. Three infants were probably cross-infected in the delivery room. Antenatal symptoms included fever in the mother, greenstained amniotic fluid, pathological cardiotocogram, premature contractions and disappearance of fetal movements. After birth the infants showed respiratory distress, fever or hypothermia, exanthema or neurological abnormalities. A gram stain of the gastric content was highly accurate in predicting listeria infection (92% sensitivity, 90% specificity). Five infants died, all within 24 h of birth; seven infants survived with and 23 without, sequelae. Factors associated with fatal outcome were a short gestational age, a low birth weight and a long interval between onset of symptoms and delivery or first dose of an appropriate antibiotic. Cephalosporins were not effective in four infants and therefore should not be given alone to pregnant women and newborn infants as long as Listeria monocytogenes infection is not excluded.