A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening
-
Giovanna Bertini
Abstract
Background: Prevention of early-onset Group B Streptococcal (GBS) infection has been attempted by employing universal maternal screening for GBS, intrapartum chemoprophylaxis, and a single dose of penicillin given to neonates in the first hour of life. This strategy, however, does not seem to prevent the occurrence of late-onset neonatal group B streptococcal disease.
Study design: We assessed early and late-onset GBS disease with the use of a before–after study designed to evaluate the implementation of intrapartum antimicrobial prophylaxis. Moreover, universal neonatal screening for colonization of GBS was carried out with swabs of the external ear canal. Newborns with GBS colonization received a preventive treatment with oral amoxicillin for 10 days.
Results: Early-onset GBS infection decreased from 0.5‰ at baseline period to 0.19‰ at the study period. The incidence of late-onset GBS disease decreased from 1:1348 (0.74‰) to 1:20,710 (0.048‰). The overall cost for universal neonatal screening paid for by the Italian Health System in the study period was US$ 31,065 with an antibiotic prophylaxis cost of US$ 2,399.
Conclusions: A combined strategy based on GBS culture screening and assessment of risk factors for perinatal GBS disease can significantly reduce the rate of both early and late-onset GBS infections.
References
1. American Academy of Pediatrics Committee on Infectious Diseases, Committee on Fetus and Newborn. Revised guidelines for prevention of early-onset group B streptococcal (GBS) disease. Pediatrics 99 (1997) 48910.1542/peds.99.3.489Search in Google Scholar PubMed
2. Baker CJ, MS Edwards: Group B streptococcal infections. In: Remington J, JO Klein: Infectious Diseases of the Fetus and Newborn Infant. 4th ed. Philadelphia, PA: WB Saunders Co; 1995Search in Google Scholar
3. Committee on Obstetric Practice. Prevention of early-onset group B streptococcal disease in newborns. ACOG committee opinion. No.173. Washington, D.C.: American College of Obstetricians and Gynecologists, 1996Search in Google Scholar
4. Dashefsky B, ER Wald, M Green: Prevention of early-onset group B streptococcal sepsis. J Pediatr112 (1988) 1039Search in Google Scholar
5. Hager WD, A Schuchat, R Gibbs, R Sweet, P Mead, JW Larsen: Prevention of perinatal group B streptococcal infection: Current controversies. Obstet Gynecol96 (2000) 141Search in Google Scholar
6. Hoshina K, Y Suzuki, H Nishida, K Kaneko, S Matsuda, M Kobayashi, N Kadoi: Trend of neonatal group B streptococcal infection during the last 15 years. Pediatr Int44 (2002) 641Search in Google Scholar
7. Kobayashi M, Y Suzuki, K Hoshina: Non-inflammatory carriage of group B Streptococcus in organs of mouse. Acta Pediatr Jpn33 (1991) 110Search in Google Scholar
8. Patel DM, PG Rhodes, MH LeBlanc, GR Graves, C Glick, J Morrison: Role of postnatal penicillin prophylaxis in prevention of neonatal group B streptococcus infection. Acta Paediatr88 (1999) 874Search in Google Scholar
9. Pinto NM, EI Soskolne, MD Pearlman, RG Faix: Neonatal early-onset group B streptococcal disease in the era of intrapartum chemoprophylaxis: residual problems. J Perinatol23 (2003) 265Search in Google Scholar
10. Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 45 (1996) RR-7:1Search in Google Scholar
11. Pyati SP, RS Pildes, NM Jacobs, RS Ramamurthy, TF Yeh, DS Raval, LD Lilien, P Amma, WI Metzger: Penicillin in infants weighing two kilograms or less with early-onset group B streptococcal disease. N Engl J Med308 (1983) 1383Search in Google Scholar
12. Schrag SJ, S Zywicki, MM Farley, AL Reingold, et al.: Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med342 (2000) 15Search in Google Scholar
13. Schrag S, R Gorwitz, K Fultz-Butts, A Schuchat: Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep51 (RR:11) (2002) 1Search in Google Scholar
14. Schuchat A: Neonatal group B streptococcal disease-screening and prevention. N Engl J Med343 (2000) 20910.1056/NEJM200007203430310Search in Google Scholar PubMed
15. Siegel JD, GH McCracken, N Threlkeld, BM dePasse, CR Rosenfeld: Single-dose penicillin prophylaxis against neonatal group B streptococcal infections. N Engl J Med303 (1980) 769Search in Google Scholar
16. Steigman AJ, EJ Bottone, BA Hanna: Intramuscular penicillin administration at birth: prevention of early onset group B streptococcal disease. Pediatrics62 (1978) 842Search in Google Scholar
17. Velaphi S, JD Siegel, GD Wendel Jr, N Cushion, WM Eid, PJ Sanchez: Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy. Pediatrics111 (2003) 541Search in Google Scholar
18. Wendel GD, KJ Leveno, PJ Sanchez, GL Jackson, DD McIntire, JD Siegel: Prevention of neonatal group B streptococcal disease: a combined intrapartum and neonatal protocol. Am J Obstet Gynecol186 (2002) 618Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Articles in the same Issue
- Non-selective fetal reduction is malpractice
- Guidelines for the management of spontaneous preterm labor
- Accuracy of second trimester fetal head circumference and biparietal diameter for predicting the time of spontaneous birth
- The association between maternal cervicovaginal proinflammatory cytokines concentrations during pregnancy and subsequent early-onset neonatal infection
- Leukocytosis might precede in-hospital eclampsia in preeclamptic women who do not receive magnesium sulfate
- Randomized prospective comparative study of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy
- Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies
- Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions
- Early weight gain does not decrease the incidence of low birth weight and small for gestational age triplets in mothers with normal pre-gestational body mass index
- Umbilical artery pulsatility index: reliability at different sampling sites
- Inferior vena cava diameter pulse waveforms in the human fetus: relationship with flow velocity waveform
- A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening
- Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function
- Congress Calendar
Articles in the same Issue
- Non-selective fetal reduction is malpractice
- Guidelines for the management of spontaneous preterm labor
- Accuracy of second trimester fetal head circumference and biparietal diameter for predicting the time of spontaneous birth
- The association between maternal cervicovaginal proinflammatory cytokines concentrations during pregnancy and subsequent early-onset neonatal infection
- Leukocytosis might precede in-hospital eclampsia in preeclamptic women who do not receive magnesium sulfate
- Randomized prospective comparative study of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy
- Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies
- Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions
- Early weight gain does not decrease the incidence of low birth weight and small for gestational age triplets in mothers with normal pre-gestational body mass index
- Umbilical artery pulsatility index: reliability at different sampling sites
- Inferior vena cava diameter pulse waveforms in the human fetus: relationship with flow velocity waveform
- A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening
- Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function
- Congress Calendar
