Current Recommendations Research Articles

Combination drug therapy in pulmonary hypertension: switch from selexipaq to intravenous trepostinil

A wide range of substances is currently available for the treatment of patients with pulmonary arterial hypertension. The current recommendations for initial drug therapy are based on the patient's risk profile. For patients at high risk, an initial triple combination therapy with different substances including prostanoids is recommended. The aim of the prospective, single-arm, unblinded study was to clarify whether PAH patients on triple therapy benefit from switching from selexipag to intravenous treprostinil. The primary endpoint was the achievement of a "low-risk" status after 6 (12) months. 27 PAH patients (45 (37; 61) years, 77.8% women) were included. At study entry they were assigned to low-risk (n=1), intermediate (n=12) or high-risk status (n=14). On average, 22 patients were followed for 8 (range 5-11) months. One patient was successfully transplanted after four months, another four patients died (in one case septic complications of unknown origin; in three cases progressive right heart failure). The primary endpoint (reaching "low-risk" status) was achieved in 12/21 (57.1%) patients (one further patient remained in "low-risk" status). These data indicate (despite the small number of patients) that even with established triple therapy, clinical improvement in individual patients is possible by switching from selexipag to intravenous treprostinil.

ICRP pregnant-female mesh-type reference computational phantoms part 1: development of fetal phantoms.

The International Commission on Radiological Protection (ICRP) decided to develop pregnant-female reference computational phantoms, including the maternal and fetal phantoms, through its 2007 general recommendations. Acknowledging the advantages of the mesh geometry, the ICRP decided to develop the pregnant-female mesh-type reference computational phantoms (MRCPs) for 8-, 10-, 15-, 20-, 25-, 30-, 35-, and 38-week fetal ages directly in the mesh format. As part of this process, the present study developed the mesh-type fetal phantoms. The reference blood-inclusive organ masses, elemental compositions, and densities were established based on various scientific literatures. Then, the phantoms were developed in accordance with the established reference dataset while reflecting the anatomical features of the developing fetus, such as fetal-age-specific anthropometric parameters, bone ossification, and contents formation time. The phantoms were developed in the tetrahedral-mesh format and can be implemented in the general-purpose Monte Carlo codes (i.e., Geant4, PHITS, MCNP6, and EGSnrc) without the necessity of the voxelization process. To explore the dosimetric impact of the developed phantoms, photon specific absorbed fractions (SAFs) were computed for energies between 10-2 to 101 MeV for the fetal liver and spleen as source regions and self-irradiation and cross-irradiation to the fetal brain, lungs, and urinary bladder wall as target regions. The SAFs showed the fetal-age-dependent dose trends (i.e., SAF decreases with increasing fetal age) due to organ masses increases via fetal growth. The mesh-type fetal phantoms, as part of the ICRP pregnant-female MRCPs, will be used to calculate reference dose coefficients for fetal members of the public for both the current and future ICRP general recommendations.

Nutritional perspectives in female soccer: a scoping review.

The purpose of the review was to evaluate the literature exploring nutritional habits and practices in female soccer players. The PRISMA-ScR Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were followed. Searches of Web of Science, PubMed and Scopus databases were conducted for studies exploring the nutritional habits and practices of female soccer players. A total of 72 studies were included in the scoping review. Studies on female soccer players mainly focused on daily energy expenditure, daily energy and macronutrient intake and hydration status. A negative energy balance was consistent across studies, and the ingestion of CHO appears below the current recommendations. Female soccer players are predominately in negative energy balance, which may indicate that they are at risk of low energy availability. A high use of nutritional supplements is apparent in female soccer, whilst a large proportion of players commence training dehydrated. The current findings have implications for practitioners relating to the planning, management, monitoring, and implementation of nutritional intake and training and competition schedules.

Advancements in textile techniques for cardiovascular tissue replacement and repair.

In cardiovascular therapeutics, procedures such as heart transplants and coronary artery bypass graft are pivotal. However, an acute shortage of organ donors increases waiting times of patients, which is reflected in negative effects on the outcome for the patient. Post-procedural complications such as thrombotic events and atherosclerotic developments may also have grave clinical implications. To address these challenges, tissue engineering is emerging as a solution, using textile technologies to synthesize biomimetic scaffolds resembling natural tissues. This comprehensive analysis explains methodologies including electrospinning, electrostatic flocking, and advanced textile techniques developed from weaving, knitting, and braiding. These techniques are evaluated in the context of fabricating cardiac patches, vascular graft constructs, stent designs, and state-of-the-art wearable sensors. We also closely examine the interaction of distinct process parameters with the biomechanical and morphological attributes of the resultant scaffolds. The research concludes by combining current findings and recommendations for subsequent investigation.

The culturability of acid-tolerant Salmonella in mayonnaise, a raw egg-based sauce

Salmonella is one of the most common bacterial foodborne pathogens and is frequently found as a contaminant of raw egg-based foods. Food safety regulations recommend the use of food acids to mitigate the risk of Salmonella persistence in raw egg-based foods. Salmonella, however, can become tolerant to acidic environments and it is not known how this can affect bacterial persistence in food. This study investigated whether acid-tolerant strains of Salmonella persisted longer in mayonnaise compared with sensitive strains. Isolates of S. typhimurium, S. infantis, S. enteritidis, and S.hessarek were used in this project. Acid-tolerant Salmonella strains were generated using a three-day step-down method where pH was decreased every 24 h from pH 7 to pH 5. Growth curves were determined for both acid-sensitive and acid-tolerant strains. Time-kill experiments were conducted to compare the survivability of acid-sensitive and acid-tolerant Salmonella serotypes in mayonnaise stored at either 5 °C or 25 °C for 72 h. Salmonella exhibited an extended lag phase with increased acid concentration, and acid-tolerant strains recovered faster in media compared with acid-sensitive strains. Elevated biofilm formation was found in acid-habituated strains compared to sensitive strains, and this varied between serotypes. The culturability of Salmonella in mayonnaise stored at 5 °C declined slower than when stored at 25 °C. Acid-tolerant strains persisted longer in mayonnaise and there was a statistically significant difference in culturability (P < 0.05). In conclusion, the current safe food recommendations to control Salmonella in raw egg-based foods are not effective in eliminating it.

The Impact of Educational Handouts on the Compliance Rate for Bariatric Patient Follow-Up Appointments.

Compliance rates for follow-up appointments are an issue for postoperative sleeve gastrectomy (SG) patients. Without consistent reinforcement and monitoring of patient progress, patients tend to gain the weight back, all of the medical improvements made are lost, and the ability to access patients for potential complications is denied. Patients need much reinforcement during their forever bariatric lifestyle, and the lack of consistent reminders may contribute to follow-up noncompliance and recidivism in SG patients. As time progresses, the follow-up appointment compliance rate decreases. Decreased follow-up can lead to a higher risk for complications such as asymptomatic esophagitis, and current recommendations suggest that esophagogastroduodenoscopy screening should occur 3years postoperatively. After 1 year, the follow-up compliance decreases dramatically so that by the 3-year postoperative period, very few patients are being seen and scheduled for interventions such as an esophagogastroduodenoscopy. The objective of this quality improvement project was to evaluate the effectiveness of a patient educational handout on SG bariatric patient follow-up visit compliance. A quasi-experimental design and retrospective chart review was chosen. An educational handout was developed. Preintervention retrospective chart review consisted of 441 SG patients expecting a follow-up in 12 to 48months. Postintervention included 3months of the handout intervention with data collection totaling 198 patients. Follow-up compliance for 4 year visits noted 0% preintervention/12.2% postintervention (P =.008), for 3 year visits 13.4% preintervention/12% postintervention (P =.846), for 2 year visits 26.3% preintervention/28.6% postintervention (P =.755), for 18months visits 26.3% preintervention/32.6% postintervention (P =.365), and for 12months visits 54.2% preintervention/34.1% postintervention (P =.011). In this quality improvement project, educational handouts did not have a statistical impact on follow-up compliance.

Differences between Current Clinical Practice and Evidence-Based Guideline Recommendations Regarding Tocolysis – an Austria-wide Survey

Differences between Current Clinical Practice and Evidence-Based Guideline Recommendations Regarding Tocolysis – an Austria-wide Survey

Colorectal Cancer Incidence and Mortality After Negative Colonoscopy Screening Results

The current recommendation for a 10-year rescreening interval after a negative colonoscopy screening (NCS) result has been questioned, with some studies showing a persistently lower risk of colorectal cancer (CRC) after NCS results. To examine long-term CRC incidence and mortality after NCS results (ie, no presence of CRC or polyps) and according to a risk score based on major demographic and lifestyle risk factors. In this cohort study, 3 prospective US population-based cohorts from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study were followed up from 1988 and 1991 to 2020. Data from the National Health and Nutrition Examination Survey (NHANES) from the January 1, 2017, to December 31, 2018, cycle were used to compare the risk profile distribution with that of the general US population. Data analysis was performed from October 2023 to August 2024. Time-varying status of NCS results and risk score. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs for incidence and mortality of CRC. A total of 195 453 participants (median [IQR] age, 44 [37-56] years at baseline; 81% female) were followed up for a median (IQR) of 12 (6-20) years. Among 81 151 individuals with NCS results and 114 302 without endoscopy, 394 and 2229 CRC cases and 167 and 637 CRC deaths, respectively, were documented. Negative colonoscopy screening results were consistently associated with lower CRC incidence (HR, 0.51; 95% CI, 0.44-0.58) and mortality (HR, 0.56; 95% CI, 0.46-0.70) for 20 years. Among individuals with NCS results, those with an intermediate risk (scores, 6-7) and low risk (scores, 0-5) did not reach the 10-year cumulative incidence of CRC (0.78%) of the high-risk individuals (scores, 8-12) until 16 and 25 years after initial screening, respectively. These findings provide evidence for shared decision-making between patients and physicians to consider extending the rescreening intervals after an NCS result beyond the currently recommended 10 years, particularly for individuals with a low-risk profile. These results showed, as a proof of concepts, the importance of considering known CRC risk factors when making decisions for colonoscopy rescreening.

European Society of Cardiology (ESC) guidelines on atrial fibrillation 2024 : What is new and what is important?

The 2024 guidelines of the European Society of Cardiology (ESC) on atrial fibrillation (AF) present current and comprehensive recommendations for the diagnosis, prevention and treatment of AF. They are based on the AF-CARE treatment pathway, which includes modification of cardiovascular risk factors, stroke prevention, symptom management and continuous re-evaluation. Accordingly, all patients with newly diagnosed AF should undergo transthoracic echocardiography. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended for the treatment of heart failure across all clinical and echocardiographic levels of left ventricular ejection fraction (LVEF). The CHA2DS2-VASc score has been simplified to the CHA2DS2-VA score for the risk assessment of thromboembolism. For rate or rhythm control pharmacotherapy with beta-blockers, digitalis, amiodarone and flecainide are still the most important drugs. Pulmonary vein isolation is now also recommended as afirst-line treatment for paroxysmal AF. Re-evaluation of risk factors and treatment of comorbidities is also emphasized. Overall the guidelines represent a further development and update based on recent studies. They remain practical and provide clear and detailed recommendations for action that are globally recognized in the clinical practice.

A Survey of the Current UK Physician Associate Educator Workforce and Recommendations for Courses and Provider Organizations.

In the United Kingdom there are 37 physician associate (PA) training programs with limited knowledge of the educators involved, their training, and specific needs. An online questionnaire was sent to PA educators in all UK training programs requesting information on academic title and responsibilities, clinical and nonclinical background, education and qualifications before becoming a PA educator, formal and informal training received in the role, and insights into career progression. The questionnaire highlighted 5 specific areas that should be specific recommendations for UK training programs to support PA educators, alongside existing guidance. These centered on academic and leadership development, clinical engagement, student support, and pedagogical research. We believe that implementing these recommendations across training programs will improve the opportunities for all those delivering PA education and consequently improve the offering to the students undertaking PA studies programmes.

Subperiosteal Abscess of the Orbit: Long-term Trends in Bacteriology and Clinical Outcomes and Current Management Recommendations.

To evaluate the impact over time of evolving upper respiratory pathogens, modified microbial terminology, and improved laboratory isolation on the bacteriology and management of sinusitis-related subperiosteal abscess of the orbit. Comparative case series of pediatric patients with bacterial sinusitis-related subperiosteal abscess from 2012 to 2022. Outcomes, culture results, age-specific findings, and antibiotic duration were compared with those in 1977 to 1992, 1988 to 1998, 1999 to 2008, and 2002 to 2012 cohorts at the same institution. Ninety-one patients met the inclusion criteria. Forty-nine patients (53.8 %) recovered with medical therapy alone; 42 (46.2 %) underwent surgical drainage. There was increased representation in surgical cases of Streptococcus anginosus group (52.4%) and anaerobes (26.2%). Anaerobes were isolated from 2 patients <9 years of age, the youngest age 5; recovery in prior series was limited to patients ≥9 years old. Among 61 of 91 patients <9 years old, 41 (67.2%) were managed medically and 20 (32.8%) underwent surgery. Comparable proportions were 67.5%/32.5%, 85%/15%, and 72%/28% in prior cohorts. Among nonsurgical patients <9 years old, the mean duration of intravenous antibiotics was 4.02 ± 1.2 days. Four patients had multiple admissions. In cases positive for aggressive pathogens, initial findings prompted timely drainage. All patients had favorable visual and systemic outcomes. This study extends to 45 years a unique analysis of the bacteriology and clinical course of subperiosteal abscess at a single center with comparatively stable patient demographics and environmental factors, using a relatively uniform treatment algorithm. Despite the increased representation of S. anginosus group and anaerobes, a multifactor protocol with minor modifications remains an effective strategy.

What Perioperative Factors Are Associated With High-risk Daily Morphine Milligram Equivalent Totals in Spinal Decompressions?

Retrospective cohort analysis. To determine what factors are associated with high-risk daily morphine milligram equivalent (MME) totals in patients undergoing spinal decompression. Daily dosages of ≥100 MME/d are associated with an almost 9-fold increased risk of overdose. Current general recommendations endorse the lowest effective dose and ≤50 MME/d. Retrospective analysis was conducted on 260 patients who underwent spinal decompressive surgery. Average MME/d was calculated as the sum of qualifying inpatient MMEs administered divided by the sum of inpatient length of stay. Independent variables across demographic, clinical, and surgical domains were subject to comparative and logistic regression analysis. Overall MME per day was 54.19 ± 39.37, with a range of 1.67-218.34 MME/d. Sixty-six patients were determined to have "high-risk MME." These patients were significantly younger (58.8 ± 13.1 vs 70.53 ± 11.5; P < 0.001) and reported higher preoperative pain visual analog scale (VAS; 4.8 ± 3 vs 2.8 ± 3.3; P = 0.0021) than the patients at low risk. In addition, high-risk patients had significantly higher body mass indexes (BMIs; P < 0.05) and received ketamine as part of anesthesia (P < 0.05). Patients who consumed high-risk dosages of MMEs in the perioperative period were more likely to have been on opioids before surgery and to report higher pain scores at 4-6 week follow-ups (P < 0.05). The final logistics regression model identified independent risk factors to be younger age, higher BMIs and preoperative VAS, and prior use of opioids and intraoperative ketamine. Patients with high MME per day who underwent spinal decompression were significantly younger with higher BMIs and preoperative VAS with an increased incidence of preoperative opioid use and intraoperative ketamine. A closer look at interaction models revealed that a combination of high preoperative pain and intraoperative ketamine usage were at a significantly increased risk of higher MME consumption. Preoperative opioid risk education and mitigation strategies should be considered in patients with high MME risk, especially in younger patients already utilizing opioids before surgery.

Impact of Enhanced Recovery After Surgery Protocol Compliance on Outcome After Pancreatic Surgery: Results From a Certified ERAS Center

Objective: The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay. Background: The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD). Methods: Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included. The datasets were retrospectively collected from a central database. The effects of individual ERAS items and compliance on morbidity and hospital stay were assessed by uni- and multivariable analyses. Results: In total, 594 patients who underwent PD (44.8%), distal pancreatectomy (14.6%), total pancreatectomy (17.8%), or other pancreatic resections (22.7%) were included. Of these, 90 patients (15.2%) achieved a high overall ERAS compliance of ≥70%. High compliance was associated with significantly less complications (Clavien–Dindo ≥ 3a), reduced 30-day mortality, and a shorter hospital stay. Early mobilization on the first postoperative day (POD1), restrictive intravenous fluid administration, and timely removal of urinary catheters were significant multivariable predictors for lower morbidity. Early mobilization on POD1 also correlated with reduced morbidity in the subcohort of PD cases. Conclusions: The pancreatic ERAS protocol can be sustainably implemented and applied to both, PD and non-PD cases. A high level of compliance with the ERAS protocol after pancreatic resections correlated with improved outcomes but was achieved by less than one-fifth of patients. Early mobilization on POD1 and restrictive fluid management were key indicators for optimized short-term outcomes.

Lowering low-density lipoprotein cholesterol targets to below 1.0 mmol/L in acute coronary syndrome patients: a potential new standard

Despite significant advancements in the diagnosis and treatment of ischemic heart disease primarily, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) plays a causal role in the development and progression of atherosclerosis. Randomized controlled trials have demonstrated that achieving lower LDL-C levels in patients with acute coronary syndrome (ACS) can stabilize or even reverse coronary plaque. This article examines existing evidence to explore whether further reducing LDL-C levels in all ACS patients (not just those with recurrent events) to below 1.0 mmol/L, lower than current guideline recommendations, could effectively reduce the incidence of adverse cardiovascular events.

Capabilities of forensic trassological examinations and the specifics of their appointment in the investigation of criminal offenses committed by organized groups or criminal organizations

The article is devoted to highlighting the capabilities and specifics of appointing forensic trassological examinations of human foot and footwear traces, vehicle traces, locking and protective (control) devices, and burglary tools in the investigation of criminal offenses committed by organized groups or criminal organizations. It has been proven that the forensic trassological examinations play a significant role in establishing the circumstances of criminal offenses committed by organized groups or criminal organizations. However, in practice, their capabilities are not fully utilized. The tasks solved by each of the studied types of examinations in the mentioned criminal proceedings have been identified, including determining the group nature of the offense, differentiating the «roles» of participants in the offense, and more. Problematic issues arising during the appointment of such examinations are outlined, and recommendations are provided regarding the preparation of objects for examination and samples for comparative research. It is noted that for proper preparation of objects when appointing the mentioned examinations, as well as for correctly formulating questions to the expert, it is advisable for the investigator to seek the assistance of a specialist who is an expert in forensic trassological studies. The author presents a viewpoint on the minimum number of shoe prints that should be reflected in the «track» of traces to obtain reliable results from expert analysis (at least 7-8 prints, sequentially left by the right and left feet of a person). Attention is drawn to the fact that current methodological recommendations for appointing forensic trassological examinations of human foot and shoe traces suggest asking the expert: «What is the approximate height of the person who left the traces?» It is noted that this question cannot be reliably answered due to the absence of scientifically validated research methods. A promising area of scientific research, as identified by the author, is the exploration of the possibilities of using other trassological examinations in the investigation of criminal offenses committed by organized groups or criminal organizations.

Deep Reinforcement Learning Recommendation System Algorithm Based on Multi-Level Attention Mechanisms

Traditional recommendation systems, which rely on static user profiles and historical interaction data, frequently face difficulties in adapting to the rapid changes in user preferences that are typical of dynamic environments. In contrast, recommendation algorithms based on deep reinforcement learning are capable of dynamically adjusting their strategies to accommodate real-time fluctuations in user preferences. However, current deep reinforcement learning recommendation algorithms encounter several challenges, including the oversight of item features associated with high long-term rewards that reflect users’ enduring interests, as well as a lack of significant relevance between user attributes and item characteristics. This leads to an inadequate extraction of personalized information. To address these issues, this study presents a novel recommendation system known as the Multi-Level Hierarchical Attention Mechanism Deep Reinforcement Recommendation (MHDRR), which is fundamentally grounded in a multi-layer attention mechanism. This mechanism consists of a local attention layer, a global attention layer, and a Transformer layer, allowing for a detailed analysis of individual attributes and interactions within short-term preferred items, while also exploring users’ long-term interests. This methodology promotes a comprehensive understanding of users’ immediate and enduring preferences, thereby improving the overall effectiveness of the system over time. Experimental results obtained from three publicly available datasets validate the effectiveness of the proposed model.

Organ-confined prostate cancer with negative surgical margins in an entirely-embedded radical prostatectomy is essentially non-lethal-a retrospective single-institutional study of 520 patients.

There is no risk-based stratification in serum PSA monitoring in prostate cancer (PCa) patients following radical prostatectomy (RP). Those patients with minimal risk of recurrence may be subjected to unnecessarily rigorous monitoring as well as to increased anxiety disproportionate to their actual prognosis. This study aimed to investigate outcomes in PCa patients with favorable pathologic parameters to see whether they can be followed less rigorously than current practice recommendations dictate. 520 consecutive entirely embedded organ-confined RPs with negative margins and undetectable initial postoperative serum PSA at the University of Chicago Medical Center between 2005 and 2017 were retrospectively identified. Clinicopathologic parameters and follow-up data including serum PSA were analyzed. No patients, regardless of their grade group (GG), developed metastasis or succumbed to a PCa-specific death. These patients had a median postoperative follow-up of 109months. 2.2% (22/520) of the patients developed biochemical recurrence (BCR). There were 163, 279, 69, 4, and 5 RPs from GG 1 to 5, respectively. Of these, 0% (0/163), 1.8% (5/279), 18.8% (13/69), 0% (0/4), and 60% (3/5) developed BCR, sequentially. In this study, organ-confined PCa with negative margins in an entirely embedded RP carried no mortality risk. In particular, the patients with GG 1-2 disease may have benefited from less rigorous monitoring. Additionally, enhanced patient reassurance could play a role in reducing anxiety in this subset of patients.

Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Pulmonary Hypertension

(Anesth Analg. 2024;138(5):1011–1019. doi: 10.1213/ANE.0000000000006523) Pulmonary hypertension (PHTN) conveys significant risk for morbidity and mortality during pregnancy leading to many patients being counseled against pregnancy or for termination should pregnancy occur. Despite this risk, some women do proceed with pregnancy beyond 25 weeks; however, information on these cases remains elusive and limited to case series or reports with small samples. Current recommendations surrounding delivery for women with PHTN recommend cesarean delivery (CD), but new evidence is showing that trial of labor in these circumstances is safe and that vaginal delivery (VD) may reduce associated rates of morbidity and mortality. This study assessed the association between mode of delivery and maternal morbidity in individuals with PHTN and pregnancies past 25 weeks of gestation, with a hypothesis that an intended VD has lower morbidity rates than intended CD.

Prophylactic Unfractionated Heparin in Antepartum Hospitalizations: A Randomized Controlled Trial

(Obstet Gynecol. 2024;144(1):118–125. doi: 10.1097/AOG.0000000000005599) Obstetric venous thromboembolism (VTE) is a significant cause of maternal morbidity and mortality, particularly in cases of prolonged antepartum hospitalizations. Comprehensive thromboembolism prevention strategies have helped reduce maternal mortality from thromboembolism. Current recommendations emphasize expanded heparin prophylaxis during antepartum hospitalizations to mitigate VTE risks. However, there is a lack of data on how pregnancy-induced physiological changes affect unfractionated heparin (UFH) disposition, potentially necessitating higher dosing during pregnancy. Studies suggest pregnant patients may require increased heparin doses due to lower peak plasma concentrations and altered coagulation parameters.

Clinician compliance to intrapartum antibiotics prophylaxis for minimising neonatal group B streptococcal infection risk.

Intrapartum antibiotic prophylaxis (IAP) administration to group B streptococcal (GBS) positive pregnant women and other pregnant women with risk factors may reduce the rate of neonatal early-onset GBS infection (EOGBSI). Our aims were estimating the current indications for IAP among women presenting in labour, evaluating compliance to the current local IAP guidelines and to provide recommendations for improving clinician compliance. We retrospectively analysed IAP data at our tertiary perinatal centre over a 16-month period. Our cohort included women, positive for GBS (± risk factors for EOGBSI), and a comparable number of randomly selected women with risk factors and GBS status negative or unknown. A total of 424 mother-baby pairs were included in this study. Forty-seven percent of the study cohort had IAP indication (n = 202/424). Of these, 72% (n = 145/202) received some form of IAP and 61% (n = 123/202) received 'adequate' IAP. IAP was adequately administered in 67% (n = 99/148) of women positive for GBS, 27% (n = 9/33) of women with unknown GBS status and 71% (n = 15/21) of women negative for GBS with IAP indication. Most frequent reason (30%, n = 125/424) for 'inadequate' IAP was less than four hours from birth for women positive for GBS despite spending more than 60 min in the hospital before birthing. A substantial number of IAP were administered less than four hours before birth and were therefore 'inadequate' according to the current recommendations. These high rates could be reduced if those administered at least two hours prior to birth were redefined as 'adequate'.