Newborn’s Illness Puts Strep B in Spotlight
Just 36 hours old, Jesse Enerle was a picture of health. A hospital pediatrician said he was perfect. But not long after his parents tucked the infant into his crib at home, he started to grunt and fuss and his breathing became heavy.
“I’d laid down for half an hour, and when I got up he’d just changed completely,” recalled Jesse’s mother, Shelene Enerle of Oxnard. His temperature soared to 102.5.
By the time Enerle and husband Chris reached St. John’s Regional Medical Center 15 minutes away, the newborn’s temperature was 103.7, his intestines had begun to shut down and doctors told the frantic parents that he might die.
Today, Jesse is a rambunctious 20-month-old towhead, cured after two brain surgeries.
“He’s my miracle,” Enerle said. “But none of this had to happen. A simple $20 test could have prevented it. And the frightening thing is that some parents don’t ever get to bring their babies home.”
Jesse suffered from meningitis caused by Group B streptococcus, a bacterial infection that experts say poses the greatest threat to the lives of newborns nationwide.
But it’s also a bacterium that is little known to the pregnant women who carry it in their genital tracts and pass it along when their babies swallow amniotic fluid during birth.
About one of every four pregnant women carry the bacteria. About 3,800 babies are sickened by full-blown strep B infections in the U.S. each year, according to the Centers for Disease Control in Atlanta. CDC estimates have been as high as 310 infant fatalities annually from strep B infections, but that number is decreasing because of more effective treatment.
Strep B infects fewer than one out of every 1,000 newborns, the CDC estimates. That would mean about 11 babies a year in Ventura County, although county health officials do not keep count. CDC researchers acknowledge their estimates are conservative. Other researchers have put the number of strep B cases as high as 12,000 a year nationwide, and deaths at 2,000.
“The precise count is not important. What people need to know is that strep B is common, and it’s bad and many of these cases can be prevented,” said Dr. Anne Schuchat, chief of the Respiratory Disease Branch at the Centers for Disease Control, and a noted strep B researcher. “Pregnant women should be told what strategies are offered to prevent it.”
Trouble is, said Shelene Enerle, she had never heard of group B strep until it struck Jesse with such virulence in July 1997. Her obstetrician had never mentioned it, she said. And she showed none of the telltale strep B signs that many obstetricians rely on before administering protective antibiotics during labor and delivery.
Warning of Risk
“I never had a chance to know anything or do anything until the devastation occurred,” she said. “And I don’t want that to happen to any other mother.”
That is why Enerle and her husband--religious singer Chris Keith Enerle--have begun an ambitious campaign they call “The Jesse Cause” to inform Ventura County women about the risks of strep B, and how they can protect their babies from it.
They have printed 8,000 pamphlets and plan to distribute them to every hospital, clinic and doctor’s office in Ventura County, she said. Through a fund-raising concert March 28 at the Bible Fellowship Church in Ventura, they hope to take their crusade to other areas.
They advocate a simple test that the CDC says is the most certain way to detect strep B--a $20 swab culture in the 35th week of pregnancy, about a month before delivery. If the bacteria are detected, obstetricians can administer inexpensive antibiotics--usually penicillin or ampicillin--during labor and delivery.
That prevents up to 80% of strep B infections, the CDC estimates.
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This method is routinely used by obstetricians at Ventura’s Community Memorial Hospital and Simi Valley Hospital. And many obstetricians say they would demand it for their own families.
“I think we’re at about 90% screening of pregnant women at CMH,” said Dr. Richard Reisman, chief of obstetrics and gynecology at Community Memorial. “The test has no risk at minimal expense. And to treat 100 women to keep one infant from being really ill is worth it.”
A second prevention method--also endorsed by the CDC--is followed by many obstetricians in the county. It does not include a routine test for strep B but relies instead on the appearance of so-called “risk factors” to prompt the use of antibiotics.
Those risk factors are premature births, fevers exceeding 100.4 degrees and the rupture of amniotic fluids more than 18 hours before delivery.
The CDC estimates that doctors’ use of this risk-based approach can cut strep B cases up to 40%, compared with 80% with screening. But the CDC estimates are theoretical and have not yet been proved in the field, Schuchat said.
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Both methods have been endorsed equally by the CDC and national groups representing pediatricians and obstetricians and gynecologists.
Until 1997, those two groups split on the preferred treatment method--the pediatricians favoring the screening of all expectant mothers to see if they carry strep B, and the obstetricians finding that unnecessary.
Many obstetricians say they still use the risk-based approach, because strep B cases are so rare universal testing is a waste of money and prompts patients to worry without real cause. Some women are also unknowingly allergic to antibiotics and are sickened when treated with them during delivery.
In addition, the use of antibiotics on a pregnant woman with no signs of risk can make those drugs less effective for her in the future by unnecessarily elevating her body’s resistance to them.
“You have to be concerned about trying to scare a patient into a treatment that hasn’t been proven effective,” said Dr. Robert Lefkowitz, chief of obstetrics and gynecology at Ventura County Medical Center, the county’s public hospital. “You start to deal with large amounts of cultures for very, very small numbers [of actual infections], for a benefit that’s difficult to prove. I wouldn’t be particularly concerned if somebody wasn’t getting the screening.”
Lefkowitz said a small percentage of the 1,800 women who deliver babies at the county hospital have been screened for strep B.
Screening Not Routine
Among Ventura County’s large hospitals, Community Memorial and Simi Valley are apparently the only ones where nearly all obstetricians routinely screen for strep B.
“Everyone kind of agrees that high-risk women should be screened, especially when babies are premature,” said Dr. Robert Grossman, who heads the ob-gyn department at Los Robles Regional Medical Center in Thousand Oaks.
He estimated that only about 15% of the 2,300 babies delivered at Los Robles each year are treated with antibiotics. “There are adverse things to consider,” he said. “Antibiotics cause drug resistance, and some women are allergic to them. So the question is, statistically, how much do you give up to cut down the risk of Beta strep?”
In his own practice, however, Grossman opts to cut the risk of strep B over the possible problems with antibiotics. He screens all pregnant women at 36 weeks and uses antibiotics on all high-risk women regardless of whether tests show them to be strep B carriers.
At St. John’s Regional Medical Center in Oxnard, only 25% to 33% of 2,300 expectant mothers are screened, said Dr. Michael Mah, director of the newborn intensive care unit.
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Yet Mah said that--if it were in his power--he would make screening mandatory. “There’s no risk,” he said. “It’s a prudent and relatively easy safety precaution.”
It can be argued convincingly, Mah said, that money used for screenings and antibiotics on women with no signs of risk--perhaps $50 a patient overall--could be better spent to hike the immunization rates of children or to improve prenatal care overall.
But the bottom line, he said, is that pregnant women should be told about strep B, so they can be screened if they choose.
Dr. David Kasting, the county’s most experienced neonatal specialist, also advocates universal screening.
“That’s the way you’re going to pick up the most moms who are strep B positive,” he said. “There are those who argue that it’s not cost effective. But if it was my own family, I’d do it. They say that passion is related to proximity.”
Doctors Affected
Indeed, Kasting has been close to a number of critically ill babies as they have suffered through strep B-caused blood, brain and lung infections, along with severe pneumonia.
He is the doctor Shelene Enerle credits with saving Jesse’s life.
“I didn’t leave his bedside that whole night,” Kasting said. “And if we can reduce the number of Jesses from happening, I’m absolutely for it.”
Dr. George Tuttle III, the Thousand Oaks obstetrician who delivered Jesse, said he was also affected by the boy’s horrifying entry into the world. Since that delivery, Tuttle said, he has screened every expectant mother to come through his office.
“I’ve been delivering kids in private practice since 1987, and I had not one group B strep problem for 10 years,” Tuttle said. “I was following the guidelines precisely. But they probably weren’t good enough.”
FYI
* For information about Group B streptococcus, a bacterial infection that poses a threat of death to newborns, contact your doctor or:
The Centers for Disease Control and Prevention, Strep B Division, at https://www.cdc.gov or call (404) 639-2215.
Group B Strep Assn. at https://www.groupbstrep.org or call (919) 932-5344.
E-mail the Jesse Cause at groupbstrep.com or call (805) 984-7933.
