# Breast milk-associated late-onset group B streptococcus sepsis in preterm triplets: A case report and literature review

## TL;DR

This case report explores a possible link between breast milk and late-onset group B streptococcus (LOGBS) sepsis in preterm triplets.

## Contribution

The study presents a unique case linking maternal GBS mastitis and breast milk to LOGBS sepsis in preterm infants.

## Key findings

- Preterm triplets developed LOGBS sepsis after maternal GBS mastitis and positive breast milk cultures.
- One triplet developed meningitis with hydrocephalus, another necrotizing enterocolitis.
- The case suggests breast milk may be a transmission route for LOGBS in preterm infants.

## Abstract

Late-onset group B streptococcus (LOGBS) sepsis is a notable cause of morbidity and mortality in preterm neonates. While the vertical transmission of group B streptococcus (GBS) during delivery is well established, the potential role of breast milk in the transmission of LOGBS is not as clearly understood. This case report examines a unique instance of preterm triplets developing LOGBS sepsis following maternal GBS mastitis, with the aim of investigating the possible association between breast milk and LOGBS infection in preterm infants.

A set of preterm male triplets born at 30 weeks of gestation were admitted to the neonatal intensive care unit. At two weeks of age, the infants showed clinical manifestations of LOGBS sepsis, including septicemia. Additionally, one of the triplets developed meningitis complicated by hydrocephalus, while another developed necrotizing enterocolitis (NEC). Concurrently, their mother was diagnosed with mastitis and her breast milk cultures tested positive for GBS. The triplets were treated with systemic antibiotics. However, triplet B subsequently required a ventriculoperitoneal shunt for hydrocephalus management, and triplet C underwent laparotomy for NEC treatment.

The occurrence of LOGBS sepsis in these preterm triplets, coupled with maternal GBS mastitis and positive breast milk cultures, raises critical questions regarding breast milk as a possible route of transmission for LOGBS. Understanding this relationship is vital for improving clinical practice, particularly in the management of recurrent infections in this vulnerable population.