Is prophylaxis of early-onset group B streptococcal disease appropriate for South Africa?

Background. Early-onset group B streptococcal (GBS) disease in neonates can be prevented by the use of intrapartum chemoprophylaxis. There are two prevention strategies, one based on risk factors and the other on culture screening for GBS. This study sought to establish whether GBS chemoprophylaxis is appropriate in a developing country such as South Africa.Methods. All neonates with early-onset GBS disease born at Johannesburg Hospital between 1 January 1995 and 21 December 1997 were reviewed. Data were collected prospectively between 1 January and 31 October 1998. Data included demographic information, obstetric information, disease characteristics, admission details and mortality. The approximate cost of implementing both strategies was determined.Results. The overal incidence of early-onset GBS was 1.16 per 1 000 live births. The rate was significantly greater in 1998 compared with the previous years. Most of the babies were born preterm (70%), and 60% required admission to the neonatal intensive care unit (lCU) (a total of 81 ICU days). Twelve of the babies died. Assuming that chemoprophylaxis would reduce the number of ICU days by half, this would save an amount of R52 000. Culture based chemoprophylaxis would cost R1O million, whereas an approach based on risk factors would cost R31140.Conclusion. In conclusion, we feel that early-onset GBS disease is sufficiently prevalent in our unit to justify the implementation of a chemoprophylaxis strategy based on risk factors. Whether other units should adopt a similar approach would depend on the local incidence of earlyonset GBS

Growth of infants born to HIV-infected women, when fed a biologically acidified starter formula with and without probiotics

Objectives: To compare the growth of HIV-exposed uninfected infants fed a biologically acidified milk formula with or without probiotics (Bifidobacterium lactis) during the first six months of life, with control infants fed a standard starter formula. Design: Multi-centre, double-blinded randomised controlled trial. Setting: Infants born to HIV-infected women delivering at one of three academic hospitals in Johannesburg, South Africa. Subjects: Consenting HIV-positive women, who had previously decided not to breast-feed, were randomised to receive one of three milk formulas for their newborn infants. Outcome measures: Comparisons of growth parameters through the first four months of life were made between infants fed the acidified formula without probiotics and those fed the control formula (“acidification effect”), and between infants fed the acidified formulas with and without added probiotics (“probiotic effect”). Results: Of 131 randomised infants, 33 (25%) did not complete the study and 13 (10%) were HIV infected, leaving 85 infants available for analysis. Infants receiving the acidified formula with probiotics had more rapid head growth (p=0.04) and showed a trend towards more rapid weight gain (p=0.06) over the first four months of life than the infants receiving the acidified formula without probiotics. No other significant differences between the feeding groups were demonstrated. Conclusions: Infants in all study groups grew well, with increased head growth and a trend towards increased weight gain for those receiving probiotics. There were no differences in morbidity between the three study groups and no evidence of adverse effects of the study formulas. SAJCN Vol. 21 (1) 2008: pp. 28-3

Growth of infants born to HIV-positive mothers fed a whey-adapted acidified starter formula with prebiotics and nucleotides

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers, but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months, displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides.Design: The design was a multi-centre, double-blinded randomised controlled trial.Setting: The study was carried out in four academic hospitals, three in Johannesburg and one in Cape Town, South Africa.Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides, with prebiotics only, or with prebiotics and nucleotides.Outcome measures: The outcome measures were the growth parameters through the first six months of life.Results: Of the 150 randomised infants, 50 did not complete the study and 16 (12.8% of those tested) were infected with HIV, leaving 84 infants available for analysis. All three formulas were tolerated well, with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good, showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and > 0.5 for weight.Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required.Keywords: milk formula; acidification; probiotics; nucleotides; infant growt

The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections

Jason A. Roberts is funded by a Practitioner Fellowship from the National Health and Medical Research Council of Australia (APP1117065) and would like to acknowledge funding from the Australian National Health and Medical Research Council for Centre of Research Excellence (APP1099452)