Sir.—We read with interest the article "Group B Streptococcal Septicemia and Delayed-Onset Diaphragmatic Hernia: A New Clinical Association" by Harris et al in the Journal (1981;135:723-725). Harris et al reported on an association between early-onset group B streptococcal septicemia and congenital hernias of the right hemidiaphragm. They reported a case and made reference to an additional 13 cases in the medical literature.
We have recently encountered four infants with this clinical association and are aware of an additional case reported by Horbar.1 Our cases were similar to the one reported by Harris et al in that there was a delayed appearance of a right-sided diaphragmatic hernia in infants with respiratory distress who were being treated with antibiotics for group B streptococcal septicemia.
Our initial patient had been weaned to room air on the sixth day of life, but increased oxygen needs, an increased respiratory rate, and a roentgenographic