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576 Genital Necrotising Fascitis in a Premature Neonate Secondary to Group B Streptococcus(Gbs) Sepsis
  1. SA Ahmed,
  2. P Sivakumar
  1. Neonatology, Luton & Dunstable Hospital NHS Foundation Trust, Luton, UK

Abstract

Background Necrotising Fascitis (NF) is primarily an adult disease but there are pediatric case series also. In the neonate, most cases of NF are attributable to secondary infection of omphalitis, balanitis, mammitis, postoperative complications, and fetal monitoring. Other associations of NF included necrotizing enterocolitis, immunodeficiency and septicemia.

Method Case report and literature review.

Results Baby boy S is a 33 wks gestation with birth weight of 1.9 kgs born to a 21 yr old mum with uneventful pregnancy. She did not have high vaginal swab screening for GBS during pregnancy. He was born in good condition not needed resuscitation. He was cardiorespiratory stable on nasogastric feeds until day 5 when he developed grunting and tachypnoea requiring intubation and ventilation. He required both conventional & High Frequency Oscillatory Ventilation. He was extubated to CPAP on day 13.

He grew Group B Streptococcus (GBS) on blood and CSF culture. He was treated with a 3 week course of IV cefotaxime & benzylpenicillin and was commenced on oral pencillin prophylaxis for 3 months. Localised scrotal skin breakdown noted on day 11 with a rapidly progressive inflammation, necrosis and gangrene skin subcutaneous tissues. Regular dressing with duoderm, supportive care and I.V antibiotic has resolved necrotising fascitis with residual scar.

Conclusion We report the first case in literature of Genital Necrotising Fascitis in premature baby with Group B Streptococcus sepsis and meninigitis. It is relatively rare and has a fulminant course with a high mortality rate. We had good result with I.V antibiotic, supportive care and conservative surgical management.

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