{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T03:06:49Z","timestamp":1784948809638,"version":"3.55.0"},"reference-count":48,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Late-onset group B\n                    <jats:italic>streptococcus<\/jats:italic>\n                    (LOGBS) sepsis is a notable cause of morbidity and mortality in preterm neonates. While the vertical transmission of group B\n                    <jats:italic>streptococcus<\/jats:italic>\n                    (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.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case presentation:<\/jats:bold>\n                    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.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    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.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.25","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T03:30:26Z","timestamp":1745206226000},"source":"Crossref","is-referenced-by-count":2,"title":["Breast milk-associated late-onset group B streptococcus sepsis in preterm triplets: A case report and literature review"],"prefix":"10.5339","volume":"2025","author":[{"given":"Manar","family":"Saleh","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesam","family":"Abuqura","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fouad","family":"Abounahia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Gad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"issue":"14:","key":"CIT0001","series-title":"Infect Drug Resist","first-page":"3207\u20133218","article-title":"Understanding factors in group B streptococcus late-onset disease","author":"Berardi\n \nA\n,","year":"2021"},{"issue":"(2):","key":"CIT0002","series-title":"Pediatrics","first-page":"e20191881","article-title":"Management of infants at risk for group B streptococcal disease","volume":"144","author":"Puopolo\n \nKM\n,","year":"2019"},{"issue":"(9):","key":"CIT0003","series-title":"Pediatr Infect Dis J","first-page":"794\u2013798","article-title":"Neurodevelopmental impairment at 1 year of age in infants with previous invasive group B streptococcal sepsis and meningitis","volume":"39","author":"Nakwa\n \nFL\n,","year":"2020"},{"issue":"65(suppl_2):","key":"CIT0004","series-title":"Clin Infect Dis","first-page":"S190\u2013S199","article-title":"Neurodevelopmental impairment in children after group B streptococcal disease worldwide: systematic review and meta-analyses","author":"Kohli-Lynch\n \nM\n,","year":"2017"},{"issue":"(3):","key":"CIT0005","series-title":"Neoreviews","first-page":"e177\u2013e188","article-title":"Updated guidance: prevention and management of perinatal group B Streptococcus infection","volume":"22","author":"Dhudasia\n \nMB\n,","year":"2021"},{"issue":"9:","key":"CIT0006","series-title":"Ther Adv Infect Dis","first-page":"20499361221142732","article-title":"Transmission of group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence","author":"Miselli\n \nF\n,","year":"2022"},{"issue":"Suppl 1:","key":"CIT0007","series-title":"J Infect","first-page":"S34\u2013S40","article-title":"The controversial role of breast milk in GBS late-onset disease","volume":"74","author":"Zimmermann\n \nP\n,","year":"2017"},{"issue":"(3):","key":"CIT0008","series-title":"JAMA Pediatr","first-page":"224\u2013233","article-title":"Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance","volume":"173","author":"Nanduri\n \nSA\n,","year":"2019"},{"issue":"(4):","key":"CIT0009","series-title":"J Pediatr Infect Dis Soc","first-page":"431\u2013438","article-title":"Risk factors for late-onset group B streptococcal disease before and after implementation of universal screening and intrapartum antibiotic prophylaxis","volume":"5","author":"Pintye\n \nJ\n,","year":"2016"},{"issue":"(2):","key":"CIT0010","series-title":"Pediatrics","first-page":"e361\u2013e368","article-title":"Group B streptococcus late-onset disease: 2003\u20132010","volume":"131","author":"Berardi\n \nA\n,","year":"2013"},{"issue":"(9):","key":"CIT0011","series-title":"Lancet Infect Dis","first-page":"1076\u20131084","article-title":"Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis","volume":"16","author":"Kwatra\n \nG\n,","year":"2016"},{"issue":"(4):","key":"CIT0012","series-title":"Microbiol Mol Biol Rev","first-page":"e00036-17","article-title":"The first microbial colonizers of the human gut: composition, activities, and health implications of the infant gut microbiota","volume":"81","author":"Milani\n \nC\n,","year":"2017"},{"issue":"16:","key":"CIT0013","series-title":"Infect Drug Resist","first-page":"3417\u20133424","article-title":"Neonatal late-onset meningitis caused by serotype III CC17 group B Streptococci aggregating in two families from Southern China","author":"Yue\n \nL\n,","year":"2023"},{"issue":"(3):","key":"CIT0014","series-title":"Pediatr Dev Pathol","first-page":"251\u2013256","article-title":"Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission","volume":"6","author":"Kotiw\n \nM\n,","year":"2003"},{"issue":"(9):","key":"CIT0015","series-title":"Eur J Pediatr","first-page":"1155\u20131158","article-title":"Infected breast milk associated with late-onset and recurrent group B streptococcal infection in neonatal twins: a genetic analysis","volume":"168","author":"Gagneur\n \nA\n,","year":"2009"},{"issue":"18:","key":"CIT0016","series-title":"BMC Pediatr","first-page":"214","article-title":"Group B streptococcus late-onset disease, contaminated breast milk and mothers persistently GBS negative: report of 3cases","author":"Nicolini\n \nG\n,","year":"2018"},{"issue":"10:","key":"CIT0017","series-title":"Front Immunol","first-page":"2402","article-title":"Growth restriction and systemic immune development in preterm piglets","author":"B\u00e6k\n \nO\n,","year":"2019"},{"issue":"(7):","key":"CIT0018","series-title":"Clin Infect Dis","first-page":"1255\u20131264","article-title":"Clinical risk factors associated with late-onset invasive group B streptococcal disease: systematic review and meta-analyses","volume":"75","author":"Karampatsas\n \nK\n,","year":"2022"},{"issue":"15:","key":"CIT0019","series-title":"Infect Drug Resist","first-page":"5345\u20135352","article-title":"Late-onset sepsis in a premature infant mediated by breast milk: mother-to-infant transmission of group B Streptococcus detected by whole-genome sequencing","author":"Li\n \nA\n,","year":"2022"},{"issue":"(5):","key":"CIT0020","series-title":"J Nippon Med Sch","first-page":"495\u2013498","article-title":"A case of bacteremia and meningitis in a neonate infected with group B Streptococcus via breastfeeding who survived without neurological sequelae: a case report","volume":"91","author":"Fukunaga\n \nR\n,","year":"2024"},{"issue":"(1):","key":"CIT0021","series-title":"Ann Clin Microbiol Antimicrob","first-page":"55","article-title":"Hypervirulent Streptococcus agalactiae septicemia in twin ex-premature infants transmitted by breast milk: report of source detection and isolate characterization using commonly available molecular diagnostic methods","volume":"19","author":"Ager\n \nEP\n,","year":"2020"},{"issue":"(4):","key":"CIT0022","series-title":"Newborn Infant Nurs Rev","first-page":"182\u2013186","article-title":"Early-and late-onset group B streptococcal infections: overview and case studies","volume":"10","author":"Siewert\n \nRC\n,","year":"2010"},{"issue":"(8):","key":"CIT0023","series-title":"J Perinatol","first-page":"691\u2013692","article-title":"Late onset group B streptococcal infection from maternal expressed breast milk in a very low birth weight infant","volume":"23","author":"Arias-Camison\n \nJM","year":"2003"},{"issue":"(3)","key":"CIT0024","series-title":"Pediatrics","article-title":"Breastfeeding and risk of late-onset group B streptococcal disease","volume":"148","author":"Ching\n \nNS\n,","year":"2021"},{"issue":"14:","key":"CIT0001","series-title":"Infect Drug Resist","first-page":"3207\u20133218","article-title":"Understanding factors in group B streptococcus late-onset disease","author":"Berardi\n \nA\n,","year":"2021"},{"issue":"(2):","key":"CIT0002","series-title":"Pediatrics","first-page":"e20191881","article-title":"Management of infants at risk for group B streptococcal disease","volume":"144","author":"Puopolo\n \nKM\n,","year":"2019"},{"issue":"(9):","key":"CIT0003","series-title":"Pediatr Infect Dis J","first-page":"794\u2013798","article-title":"Neurodevelopmental impairment at 1 year of age in infants with previous invasive group B streptococcal sepsis and meningitis","volume":"39","author":"Nakwa\n \nFL\n,","year":"2020"},{"issue":"65(suppl_2):","key":"CIT0004","series-title":"Clin Infect Dis","first-page":"S190\u2013S199","article-title":"Neurodevelopmental impairment in children after group B streptococcal disease worldwide: systematic review and meta-analyses","author":"Kohli-Lynch\n \nM\n,","year":"2017"},{"issue":"(3):","key":"CIT0005","series-title":"Neoreviews","first-page":"e177\u2013e188","article-title":"Updated guidance: prevention and management of perinatal group B Streptococcus infection","volume":"22","author":"Dhudasia\n \nMB\n,","year":"2021"},{"issue":"9:","key":"CIT0006","series-title":"Ther Adv Infect Dis","first-page":"20499361221142732","article-title":"Transmission of group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence","author":"Miselli\n \nF\n,","year":"2022"},{"issue":"Suppl 1:","key":"CIT0007","series-title":"J Infect","first-page":"S34\u2013S40","article-title":"The controversial role of breast milk in GBS late-onset disease","volume":"74","author":"Zimmermann\n \nP\n,","year":"2017"},{"issue":"(3):","key":"CIT0008","series-title":"JAMA Pediatr","first-page":"224\u2013233","article-title":"Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance","volume":"173","author":"Nanduri\n \nSA\n,","year":"2019"},{"issue":"(4):","key":"CIT0009","series-title":"J Pediatr Infect Dis Soc","first-page":"431\u2013438","article-title":"Risk factors for late-onset group B streptococcal disease before and after implementation of universal screening and intrapartum antibiotic prophylaxis","volume":"5","author":"Pintye\n \nJ\n,","year":"2016"},{"issue":"(2):","key":"CIT0010","series-title":"Pediatrics","first-page":"e361\u2013e368","article-title":"Group B streptococcus late-onset disease: 2003\u20132010","volume":"131","author":"Berardi\n \nA\n,","year":"2013"},{"issue":"(9):","key":"CIT0011","series-title":"Lancet Infect Dis","first-page":"1076\u20131084","article-title":"Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis","volume":"16","author":"Kwatra\n \nG\n,","year":"2016"},{"issue":"(4):","key":"CIT0012","series-title":"Microbiol Mol Biol Rev","first-page":"e00036-17","article-title":"The first microbial colonizers of the human gut: composition, activities, and health implications of the infant gut microbiota","volume":"81","author":"Milani\n \nC\n,","year":"2017"},{"issue":"16:","key":"CIT0013","series-title":"Infect Drug Resist","first-page":"3417\u20133424","article-title":"Neonatal late-onset meningitis caused by serotype III CC17 group B Streptococci aggregating in two families from Southern China","author":"Yue\n \nL\n,","year":"2023"},{"issue":"(3):","key":"CIT0014","series-title":"Pediatr Dev Pathol","first-page":"251\u2013256","article-title":"Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission","volume":"6","author":"Kotiw\n \nM\n,","year":"2003"},{"issue":"(9):","key":"CIT0015","series-title":"Eur J Pediatr","first-page":"1155\u20131158","article-title":"Infected breast milk associated with late-onset and recurrent group B streptococcal infection in neonatal twins: a genetic analysis","volume":"168","author":"Gagneur\n \nA\n,","year":"2009"},{"issue":"18:","key":"CIT0016","series-title":"BMC Pediatr","first-page":"214","article-title":"Group B streptococcus late-onset disease, contaminated breast milk and mothers persistently GBS negative: report of 3cases","author":"Nicolini\n \nG\n,","year":"2018"},{"issue":"10:","key":"CIT0017","series-title":"Front Immunol","first-page":"2402","article-title":"Growth restriction and systemic immune development in preterm piglets","author":"B\u00e6k\n \nO\n,","year":"2019"},{"issue":"(7):","key":"CIT0018","series-title":"Clin Infect Dis","first-page":"1255\u20131264","article-title":"Clinical risk factors associated with late-onset invasive group B streptococcal disease: systematic review and meta-analyses","volume":"75","author":"Karampatsas\n \nK\n,","year":"2022"},{"issue":"15:","key":"CIT0019","series-title":"Infect Drug Resist","first-page":"5345\u20135352","article-title":"Late-onset sepsis in a premature infant mediated by breast milk: mother-to-infant transmission of group B Streptococcus detected by whole-genome sequencing","author":"Li\n \nA\n,","year":"2022"},{"issue":"(5):","key":"CIT0020","series-title":"J Nippon Med Sch","first-page":"495\u2013498","article-title":"A case of bacteremia and meningitis in a neonate infected with group B Streptococcus via breastfeeding who survived without neurological sequelae: a case report","volume":"91","author":"Fukunaga\n \nR\n,","year":"2024"},{"issue":"(1):","key":"CIT0021","series-title":"Ann Clin Microbiol Antimicrob","first-page":"55","article-title":"Hypervirulent Streptococcus agalactiae septicemia in twin ex-premature infants transmitted by breast milk: report of source detection and isolate characterization using commonly available molecular diagnostic methods","volume":"19","author":"Ager\n \nEP\n,","year":"2020"},{"issue":"(4):","key":"CIT0022","series-title":"Newborn Infant Nurs Rev","first-page":"182\u2013186","article-title":"Early-and late-onset group B streptococcal infections: overview and case studies","volume":"10","author":"Siewert\n \nRC\n,","year":"2010"},{"issue":"(8):","key":"CIT0023","series-title":"J Perinatol","first-page":"691\u2013692","article-title":"Late onset group B streptococcal infection from maternal expressed breast milk in a very low birth weight infant","volume":"23","author":"Arias-Camison\n \nJM","year":"2003"},{"issue":"(3)","key":"CIT0024","series-title":"Pediatrics","article-title":"Breastfeeding and risk of late-onset group B streptococcal 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