Cow's milk and the emergence of group B streptococcal disease in newborn babies.

BACKGROUND: Group B streptococcus (GBS), the most significant cause of neonatal bacterial sepsis, is thought to have emerged in the 1960s. GBS also causes mastitis in cows, and there is indirect evidence that human GBS is derived from a bovine ancestor. OBJECTIVE: A major change in the collection of milk from farms, using bulk tanks rather than churns, occurred in the 1960s. We sought to define the temporal relationship between this change in farming and the emergence of GBS neonatal disease. METHODS: We searched PubMed for reports of GBS disease from 1930 until 1980 to more exactly determine the time of emergence of neonatal infection and supported this data with UK hospital admission statistics for GBS infections. We identified the dates of the change from churns to bulk tanks by searching the internet and books for information on the history of milk transportation, farming and milk collection in the UK. RESULTS: There are no PubMed reports of neonatal GBS disease between 1930 and 1950, and reports from the UK only emerged in the mid-1960s, confirming the notion that GBS neonatal infection was a newly emergent disease in the 1960s. No national data on hospital admissions are available around this time, but the Oxford Record Linkage Study, with admission data available for Oxford from 1968, showed no cases of neonatal disease until 1974. Cow's milk collection in the UK switched to bulk tank between 1960 and 1979, and publications relating to GBS disease emerged soon after. CONCLUSIONS: There is a temporal relationship between the emergence of neonatal GBS disease reports in the UK in the 1960s and a change in cow's milk collection. This finding may be a temporal coincidence or may add support to the notion that human GBS was historically derived from a bovine ancestor

Optimising neonatal service provision for preterm babies born between 27 and 31 weeks gestation in England (OPTIPREM), using national data, qualitative research and economic analysis: a study protocol

Introduction: In England, for babies born at 23-26 weeks gestation, care in a Neonatal Intensive Care unit (NICU) as opposed to a Local Neonatal Unit (LNU) improves survival to discharge. This evidence is shaping neonatal health services. In contrast, there is no evidence to guide location of care for the next most vulnerable group (born at 27-31 weeks gestation) whose care is currently spread between 45 NICU and 84 LNU in England. This group represents 12% of preterm births in England and over a third of all neonatal unit care days. Compared to those born at 23-26 weeks gestation they account for four times more admissions and twice as many NHS bed days/year. Methods: In this mixed methods study our primary objective is to assess, for babies born at 27-31 weeks gestation and admitted to a neonatal unit in England, whether care in a NICU versus a LNU impacts on survival and key morbidities (up to age 1 year), at each gestational age in weeks. Routinely recorded data extracted from real-time, point-of-care patient management systems held in the National Neonatal Research Database, Hospital Episode Statistics and Office for National Statistics, for January 2014 to December 2018, will be analysed. Secondary objectives are to assess a)whether differences in care provided, rather than a focus on LNU/NICU designation, drives gestation-specific outcomes, b)where care is most cost-effective, c)what parents’ and clinicians' perspectives are on place of care, and how these could guide clinical decision-making. Our findings will be used to develop recommendations, in collaboration with national bodies, to inform clinical practice, commissioning and policy making. The project is supported by a parent advisory panel, and a study steering committee. Ethics and dissemination: Research ethics approval has been obtained (IRAS 212304). Dissemination will be through publication of findings and development of recommendations for care. Strengths and Limitations of this Study Strengths Scientific evidence from this study will be used to develop national recommendations for health service delivery for babies born between 27-31 weeks gestation in England. This will be guided by clinical outcomes, cost-effectiveness, parents’ and staff perspectives. Limitations As a retrospective population-based observational cohort study it is subject to selection bias in the assignment of location of birth of babies. Heterogeneity in the quality of care provided within and between LNU and NICU, is likely, and will be addressed. Formal study-driven neurodevelopmental follow up is not cost-effective in this large cohort, so routinely collected data will be used to investigate their outcomes