# Group B Streptococcus Sepsis with Cardiac Abscesses in a Neonate with Migrated Umbilical Catheter: Literature Review

## TL;DR

A premature neonate with a migrated umbilical catheter developed fatal Group B Streptococcus sepsis and cardiac abscesses, highlighting risks of catheter misplacement.

## Contribution

This case is the first to describe fatal GBS sepsis with isolated multifocal myocardial abscesses due to migrated umbilical catheter.

## Key findings

- GBS sepsis led to multiple cardiac abscesses in a neonate with a migrated umbilical catheter.
- Intracardiac catheter migration may cause endocardial trauma, enabling bacterial abscess formation.
- Proper catheter management and positioning are critical to prevent such complications.

## Abstract

Group B
Streptococcus
(GBS) is the leading cause of sepsis, pneumonia, and/or meningitis in neonates. Insertion of an umbilical catheter (UC) is a common practice in neonatal intensive care for primary central vascular access in extreme premature neonates. UC is used for the administration of intravenous medications, parenteral nutrition, blood samplings, and continuous central blood pressure monitoring. Malposition or migration of UC tends to occur in extreme premature infants with risks of multiple complications. We present a case of an extreme premature neonate who developed fatal GBS sepsis with autopsy findings of multiple cardiac abscesses in the myocardium but not in any other organ. GBS sepsis with isolated multifocal myocardial abscesses leading to sudden fatal clinical deterioration has not been described previously. In this review, we describe the plausible pathological mechanism of this rare presentation. Intracardiac migrated UC, in conjunction with rhythmic heart contractions and intracardiac blood flow dynamics, can cause direct trauma to the endocardium. Damaged endocardium can be a potential nidus for bacterial overgrowth and abscess formation that ultimately may lead to cardiac failure. Therefore, the correct aseptic technique of securing and management of UC, and daily assessment of UC position are recommended to prevent complications associated with catheter migration.