Cocooned Health

Ep 21. "My child has a fever - What do I do?" From Newborn to Teenager. Expert Guest: Dr Seilesh Kadambari  
Today our episode is a crucial one for all parents - it is a focus on fever in children with a focus on how fever differs based on the AGE of your child - from newborn to teenager. 
At Cocooned Health we often focus on the advice around vaccines, food and immune health, how to protect against common and rare, but serious, infections and today we dive into the commonly asked question - my child has a fever - what should I do? As co-hosts Dr Lydia Yarlott and Dr Eliz Kilich we have great privilege to welcome our special guest: Dr Seilesh Kadambari who is a consultant in paediatric infectious diseases and an Honorary Associate Professor at UCL Great Ormond Street Institute of Child Health known as GOSH. We will discuss today: understanding fever in children of different ages, the myths, when to seek medical attention, the science behind a fever with vaccinations along with insight into how specialists think about fever in your child and the evidence that supports it. 

Part 2: Group B Streptococcus (GBS) What is the evidence for screening all pregnant women with a swab? 
One doctor would get the swab on the private system in the UK and another would not
Listen Now.
(June's Episode Re-released: Apologies we had a technical issue with this episode where it was unintentionally shortened in some apps - now resolved)
Dr Lydia Yarlott and Dr Eliz Kilich discuss the two sides of the coin: To get the screening swab for Group B Streptococcus (GBS) or not. The discussion revolves around why different countries have different policies. GBS is a bacteria carries by around 1 in 4 people and can cause sepsis, pneumonia and meningitis in babies when a mother who carries the bacteria (as part of her normal microflora) inadvertently transfers it to baby during delivery of her baby. It is however rare. We follow up on the previous episode with Professor Kirsty Le Doare, an expert in GBS and a leader in running the trials that will hopefully lead to a GBS vaccine for the public in the future. Thus the discussion follows:
1. What are the benefits of the swab as part of screening and if your country of residence does not offer it as routine, would the hosts consider getting it. Spoiler - one would, one wouldn't
2. What are the risk of the bacteria to the baby and what is the actual numerical risk. How many babies need to be delivered to a mum who carries the bacteria for one of the babies to actually get the disease? 
3. Are there any downsides to the antibiotics in labour for GBS given that there will be some people due to screening who get it that may not have needed it? If so is there actual proof? How to we weigh this up against the risk of severe illness to baby? 
4. What was the evidence that led to some of the differing recommendations and why can't we do a study now.
 
References:
Azad, M. B. et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG 123: 983-993. (2015)
Corvaglia. et al. Influence of intrapartum antibiotic prophylaxis for Group B Streptococcus on gut microbiota in the first month of life. JPGN 62: 304-308. (2016)
Gensollen, et al. How colonization by microbiota in early life shapes the immune system. Science 352(6285): 539-543. (2016)
Group B Streptococcus Incidence. Rates of GBS infection in Babies. Group B Strep Support Charity: https://gbss.org.uk/professional-resources/gbs-incidence/ Accessed June 2025
Le Doare, K. et al. Intrapartum antibiotic chemoprophylaxis policies for prevention of Group B Streptococcal disease worldwide: Systematic Review. Clin Infect Dis 65(S2): S143-S151. (2017)
Matorras et al.  Maternal colonization by group B streptococci and puerperal infection; analysis of intrapartum chemoprophylaxis. Eur J Obstet Gynecol Reprod Biol 38(3): 203-207. (1991)
Mazzola et al. Early gut microbiota perturbations following intrapartum antibiotic prophylaxis to prevent group B streptococcal disease. PLoS ONE 11(6): e015727. (2016)
Nanduri et al. 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. JAMA Pediatr 173(3): 224-233. (2019)
Ohlsson, A et al. Intrapartum antibiotics for known maternal group B streptococcal colonization. Cochrane Database Syst Rev 1: CD007467. (2013)
Puopolo, K. M. et al. American Academy of Pediatrics, Committee on Fetus and Newborn, Committee on Infectious Diseases et al. Management of infants at risk for Group B Streptococcal disease. Pediatrics 144 (2): e20191881. (2019)
Van Dyke, M. K. et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 360(25): 2626-2636. (2009)Whilst no information is perfect, it changes, we have done our best to bring together information to the best of our knowledge. It is always important to discuss anything we talk about with your own healthcare provider. This is not direct personal medical advice as you are not our patients however, we want to give the public the information we already have, so you are more informed to make your own choices.

The Swab That Saved Their Baby - Talking about Group B Streptococcus, global screening programs differences and what options there are for pregnant women 
Welcome to Cocooned Health, the podcast where we discuss infections in pregnancy and newborns and beyond. Not only do we discuss the advice given, but talk about the reasons why such guidance exists. We help to answer questions the public have on these topics. Today, we are thrilled to be joined by Professor Kirsty Le Doare, a distinguished clinician-scientist specializing in paediatric infectious diseases. This episode will focus on the important vaginal swab or urine test results that is received for many before giving birth and the bug it is related to Group B Streptococcus.
Professor Le Doare joined St George’s, University of London (SGUL) in 2018, transitioning from Imperial College London, and brings a wealth of experience from her work in the UK, the Gambia, Uganda and South Africa.
Currently holding a Chair in Vaccinology and Immunology, Professor Le Doare is a Principal Scientist at Makerere University in Uganda. There, she leads groundbreaking research, including the development of maternal vaccine platforms and the surveillance of pregnancy outcomes in a large urban cohort. Her research focuses on age-related immune responses to infectious diseases in pregnant women and their babies, with a particular interest in how maternal antibodies in blood and breast milk protect newborns and how vaccination can enhance this natural defence.
Professor Le Doare’s work is shaping the future of maternal and neonatal health, with her team conducting clinical trials of investigative vaccines globally. She also holds a dual appointment with Public Health England as a Principal Scientist within the Pathogen Immunity Group at Porton Down. She is currently working as a consultant at the WHO on Group B Streptococcal vaccines.
Join us as we dive into her remarkable career, her cutting-edge research, and the global impact of her work in maternal and infant health. We will pay particular attention to one of her special interests GBS or Group B Streptococcus.
Disclaimer: Remember we are sharing our opinions and medical knowledge, and not associated with our affiliations. Note that knowledge evolves over time. Note that this is not direct medical advice as we are not your personal doctors however feel free to share any ideas expressed with your own healthcare professional as needed. This episode is unsponsored and received no financial incentive. 
 

Whats the impact of a western diet in pregnancy on child development? Expert Guests: Professor Morten Arendt Rasmussen and Dr David Horner
It is unclear what the impact of a western diet is like on the unborn child. Now, a large observational clinical study from the University of Copenhagen and the Copenhagen Prospective Studies on Asthma in Childhood at the Danish Paediatric Asthma Centre, Herlow and Gentofte Hospital, find a relationship between maternal diet during pregnancy and the presence of ADHD and autism in children. The more of a Western diet a woman has in pregnancy - e.g. high in fat, sugar, processed products while lower in fish, fresh vegetables, and fruit—the greater the risk appears to be for her child developing ADHD or autism. Today we are joined by Professor Morten Arendt Rasmussen and Dr David Horner University of Copenhagen who led on this research to tell us what this means for pregnant women. Thank you do being with us todayDisclaimer: Remember we are sharing our opinions and medical knowledge, and not associated with our affiliations. Note that knowledge evolves over time. Note that this is not direct medical advice as we are not your personal doctors however feel free to share any ideas expressed with your own healthcare professional as needed. This episode is unsponsored and received no financial incentive. 
 

Ep 17. Should I get the new RSV vaccine in pregnancy? When, and why?
 
RSV. Talking About Health Optimisation Part 2 -  How to protect against a disease that affects 90% of children under the age of 2 years. Around 90% of children are infected with Respiratory Syncytial Virus (RSV) by 2 years old. This episode discusses health consciousness and the desire to protect oneself. Discussions revolve around prevention medicine and how that coincides with other healthy lifestyle choices like organic food, exercise and mindfulness. We discuss how to balance the rare side effects with health optimisation. In this episode Dr Lydia Yarlott and Dr Eliz Kilich talk about how to balance the benefits and risks when thinking about vaccines. Disclaimer: Remember we are sharing our opinions and medical knowledge, and not associated with our affiliations. Note that knowledge evolves over time. Note that this is not direct medical advice as we are not your personal doctors however feel free to share any ideas expressed with your own healthcare professional as needed. This episode is unsponsored and received no financial incentive. 

Episode 16: Pregnancy RSV Vaccine Update. Expert Guest: Professor Paul Heath. Join us for an update on the respiratory syncytial virus (RSV) vaccine given during pregnancy. Hear what the latest evidence is. This vaccine protects babies against a common cause of bronchiolitis which can be severe in newborns. The UK has made a decision to prevent against RSV with Abrysvo™, the maternal vaccine, manufactured by Pfizer. Previously the UK had been considering the use of Nirsevimab instead. This is an RSV monoclonal antibody for newborns (Beyfortus™, manufactured by Sanofi Pasteur). Both the vaccine and the antibody were recommended as safe and effective options in 2023 by the JCVI. After a cost-effectiveness analysis and financial tender by the Department of Health, a decision was made to move to Abrysvo™.
The maternal vaccine success was revealed following a study involving over 7000 pregnant women, published in early 2023, the MATISSE trial. They showed that the Abrysvo™ maternal vaccine is highly effective at preventing severe infection in babies up to 180 days after birth. Vaccination is approved from 28 weeks of pregnancy in the UK. At the same time, the MELODY and HARMONIE trials showed the monoclonal antibody for babies Beyfortus™, currently unavailable in the UK, also effectively prevents RSV for up to 6 months after administration. This vaccine can be given to all babies anytime from birth. 
We now we hear about what the evidence is now that the UK has been giving the vaccine since September 2024.Tune in now. Disclaimer: Remember we are sharing our opinions and medical knowledge, and not associated with our affiliations. Note that knowledge evolves over time. Note that this is not direct medical advice as we are not your personal doctors however feel free to share any ideas expressed with your own healthcare professional as needed. This episode is unsponsored and received no financial incentive. 

Episode 15: Debrief: Cravings and Places: when your pregnancy craving lead you astray 
Dr Eliz Kilich and Dr Lydia Yarlott. In this follow-up to our insightful discussion with Dr. Matthew Gilmour in "Ep 14: Brie-ing Safe in Pregnancy – Christmas Special!", we delve deeper into the nuances of food safety during pregnancy.We summarise the main points in a shorter recap and highlight some of the areas that need further explanation. For instance here we talk about Listeria's rarity, the outbreaks, the food industry's role in protecting pregnant women, and practicalities. This episode offers practical advice on identifying actual risks, understanding potential consequences of consuming high-risk foods, and recognising the most hazardous items to avoid.We also examine the significant 2019 listeriosis outbreak in UK hospitals linked to pre-packaged sandwiches. Our discussion covers the events, the subsequent investigation by the UK Health Security Agency (UKHSA), and the lessons learned to enhance food safety protocols.assets.publishing.service.gov.uk
Resources:UKHSA's report on the 2019 listeriosis outbreak: https://assets.publishing.service.gov.uk/media/5fbd0f898fa8f559e9ea363e/2019-05-Listeria-CC8-Outbreak-Report.pdf
Tune in to gain valuable insights and join our debate on this critical topic. Please remember this is not direct medical advice, sharing knowledge and thoughts. Please do contact your own healthcare professional if seeking personal medical adviceDisclaimer: Remember we are sharing our opinions and medical knowledge, and not associated with our affiliations. Note that knowledge evolves over time. Note that this is not direct medical advice as we are not your personal doctors however feel free to share any ideas expressed with your own healthcare professional as needed. This episode is unsponsored and received no financial incentive.