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Biomedical subjects

S P Gotoff

Publications and source records attributed to S P Gotoff.

At least 19 recordsLinked to original sources
PubMed2000

Chemoprophylaxis of early-onset group B streptococcal disease in 1999.

The evolution of the guidelines for selective intrapartum chemoprophylaxis (SIC) of group B streptococcal early-onset disease is reviewed here. To assess the benefits of the risk-based and culture-based strategies for prevention, observational studies since 1996 are summarized. The effect of chorioamnionitis on group B streptococcal early-onset disease, despite SIC, is emphasized. Optimal management remains controversial, and alternative strategies for the selection of women for chemoprophylaxis and for the management of infants are discussed.

Age of Onset↗
PubMed1994

Prevention of neonatal necrotizing enterocolitis.

There are a number of promising strategies to prevent necrotizing enterocolitis (NEC). These included induction of intestinal maturation with prenatal or postnatal steroids, passive immunization with oral immunoglobulin, modification of enteral feedings, administration of oral antibiotics to decrease bacterial overgrowth while avoiding the development of resistant strains, and acidification of oral fluids to prevent bacterial overgrowth. The initial results need to be confirmed, but it is likely that one or more of these prevention measures will lower the incidence of NEC in the future.

Aminoglycosides↗
PubMed1992

Development of IgM antibody to group B Streptococcus type III in human infants.

An ELISA was developed to measure IgM antibody to albumin-coupled native capsular polysaccharide of type III group B streptococcus (GBS). The assay was standardized by two double-label methods that agreed within 33%. In quantitative assays, the range of IgM antibody to type III GBS in the sera of 94 adult pregnant women was 1.2-50.6 micrograms/ml (median, 5.4), while each of 38 cord serum samples contained less than 0.03 micrograms/ml IgM antibody. Neonatal rats were passively immunized with a serially diluted human serum containing 15 micrograms/ml IgM and undetectable IgG antibody to type III GBS. The rats were protected against lethal infection with an IgM antibody concentration of 0.5 micrograms/ml. In single serum samples from 31 healthy infants less than 2 years old and serial specimens from 5 infants with type III GBS infections, specific IgM antibody was detectable by 3 months of age. Levels greater than or equal to 0.5 micrograms/ml were present in all samples from infants greater than 7 months of age. The acquisition of specific IgM antibody is inversely correlated with the age-limited incidence of type III GBS infections in young children.

Aging↗
PubMed1988

Antimicrobial prophylaxis of neonatal group B streptococcal sepsis.

This article reviews available studies on prevention of neonatal group B streptococcal infections with antimicrobial prophylaxis. The data show that short-term administration of ampicillin to parturients with prenatal streptococcal colonization and perinatal risk factors effectively prevents these serious infections. A strong case can be made for prenatal screening for group B streptococcal carriage to identify mothers whose babies are at risk.

Anti-Bacterial Agents↗
PubMed1986

Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis.

Most cases of neonatal group B streptococcal disease with early onset have an intrapartum pathogenesis. Attack rates are increased substantially in infants born to mothers with prenatal group B streptococcal colonization and various perinatal risk factors (premature labor, prolonged membrane rupture, or intrapartum fever). In a randomized controlled trial, we studied the effect of selective intrapartum prophylaxis with ampicillin in 160 such high-risk women. In infants born to mothers who received intravenous ampicillin during labor, as compared with controls who received no treatment, neonatal colonization with group B streptococci was present in 8 of 85 (9 percent) versus 40 of 79 (51 percent; P less than 0.001), colonization at multiple (greater than or equal to 3) sites was observed in 3 of 85 (4 percent) versus 24 of 79 (30 percent; P less than 0.001), and bacteremia occurred in none of 85 versus 5 of 79 (6 percent; P = 0.024). The side effects of ampicillin were limited to a single episode of urticaria in a mother who had no history of penicillin allergy. We conclude that intrapartum ampicillin prophylaxis in women with positive prenatal cultures for group B streptococci who have certain perinatal risk factors can prevent early-onset neonatal group B streptococcal disease.

Ampicillin↗
PubMed1986

Human IgG antibody to group b Streptococcus type III: comparison of protective levels in a murine model with levels in infected human neonates.

We determined the serum concentration of human IgG antibody to the native capsular polysaccharide of group B Streptococcus (GBS) type III needed to passively protect mice against lethal homologous challenge. Antibody was measured by an ELISA, standardized by two methods, and corrected for nonprecipitating antibody. A concentration of 1.3 micrograms of IgG antibody to GBS type III/ml protected 126 (97%) of 130 mice from an 80%-96% lethal dose bacterial challenge. Concentrations of IgG antibody to GBS type III in sera from 42 infected infants were less than or equal to 0.3 micrograms/ml. Concentrations of antibody ranged from less than 0.02 to 21.7 micrograms/ml in sera from 102 unselected pregnant women (median, 0.05 microgram/ml); 13% had concentrations greater than or equal to 1.3 microgram/ml. Levels in 25 women colonized with GBS type III who gave birth to normal infants were significantly higher and ranged from 0.1 to 10.7 microgram/ml (median, 0.78 micrograms/ml). In a study of transplacental passage of antibody, protective levels were found in a number of infants with gestational ages between 28 and 36 weeks.

Animals↗
PubMed1985

Immunoprophylaxis and immunotherapy of neonatal group B streptococcal infections.

With emphasis on work from our laboratory, this paper briefly reviews previous studies which have established the basis for immunity to group B streptococcal infections. Quantitative data are presented on the concentration of antibody to the type-specific polysaccharides of group B streptococci in normal adults and infected infants, the protective level in experimental animals, and the influence of prematurity on transplacental passage of antibody. The role of the polymorphonuclear leukocyte in immunity to group B streptococcal infections is critical as supported by in vitro and in vivo experiments as well as clinical observations. Strategies for prevention include antimicrobial chemoprophylaxis and active immunization. Alternative approaches to adjunctive therapy such as administration of specific immune globulin, polymorphonuclear leukocytes, and exchange transfusions are discussed.

Animals↗