Incidence Of Early-onset Group B Streptococcal Disease Research Articles

Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019.

BackgroundNeonatal early-onset disease caused by group B Streptococcus (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.AimThe aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.MethodsIn 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995-2011) and Period II (2012-2019) were collected from each national register, covering 6,605,564 live births.ResultsIn Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34-0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80-1.0), specifically 0.89 (95% CI: 0.70-1.5) in Denmark, 0.34 (95% CI: 0.15-0.81) in Iceland, 0.72 (95% CI: 0.59-0.88) in Norway and 0.97 (95% CI: 0.85-1.1) in Sweden.ConclusionsIn this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.

The Role for Intra-Partum Antibiotics in Previously GBS-Colonised Pregnancies, Not So Straightforward After All: A Case Study

Background: Group B Streptococcus (GBS) is the most frequent pathogen involved in early-onset infection in newborn infants. The incidence of early-onset GBS disease (EOGBS) is estimated at 0.4 and 0.57 per 1000 births in the United States of America and the United Kingdom respectively. It is clear that administration of intrapartum antibiotics (IAP) significantly reduces risk of EOGBS (RR 0.17, 95% CI 0.04 to 0.74; number needed to treat to benefit 25, 95% CI 14 to 100), hence institutes such as the Royal College of Obstetrics and Gynecology (RCOG), and American College of Obstetrics and Gynecology (ACOG), have released clinical practice guidelines (CPGs) with the aim to improve the standard of care in GBS screening and IAP for the prevention of EOGBS in neonates. CPGs guide clinicians in their management based on a consensus of care drawn from clinical evidence and offer a standard of care for them to fall back on to guard against medical malpractice litigation. However, deviation from the intended clinical context or the failure to recognize the limits of such guidelines could compromise patient safety. Aim: The aim of this case study is to highlight the role and limitations of clinical practice guidelines in medical practice, through a case of an early onset GBS infection in a neonate that was a result of selectively applying the RCOG and ACOG guidelines outside their intended context. Conclusion: The case illustrates the importance of applying guidelines correctly within the appropriate clinical context but serves also as a reminder for clinicians to understand the limitations of them when accounting for other co-conditions patients often present with in daily medical practice.

The Febrile Infant: Where Art Meets Science to Prevent Harm.

1. Mobeen H. Rathore, MD, CPE* 1. *Editorial Board Member, Pediatrics in Review > With a nod (tongue in cheek) to the author’s previously published title (1) > One consistent thought continues to hold true when it comes to assessing the febrile infant. Be suspicious. > > —JZ, HDA Perhaps Dr Arnold Smith put it most eloquently: “Sorting out the child at risk, from those with illness that is not a threat to their health, is a fundamental goal of pediatrics” (Fig 1). (2) What Dr Smith wrote 40 years ago is true even today. Fever continues to be one of the most common ailments in children. Although fever is a friend of the patient, infection is a foe. Identifying the foe is a complicated task for the evaluating physician. This is even more challenging in infants and especially neonates because of less-than-optimal history, mostly unreliable examination, and more specific signs of infection in the neonates often appearing later in the disease course. Even a thorough laboratory evaluation is not always helpful. Ultimately it is the selection of optimum broad spectrum empirical antibiotic drug therapy that is really the most important decision to protect neonates from the serious morbidity and mortality of neonatal sepsis. Fortunately, most infections in children, including in neonates, are viral and self-limited, causing no serious morbidity. Unfortunately, rarely, bacterial infections can be serious and sometimes life-threatening. Herein lies the challenge even for the most experienced and knowledgeable …

Burden and risk factors of invasive group B Streptococcus disease among neonates in a Chinese maternity hospital

BackgroundThere is a lack of data regarding the prevalence of invasive group B streptococcus (GBS) infection among neonates in China. This study aimed to investigate the incidence and mortality of invasive GBS infection and to identify the risk factors in our hospital.MethodsSeventy-four cases admitted between January 2011 and December 2016 was included in this study. A retrospective matched case-control study was conducted in a tertiary maternity and paediatric hospital. Risk factors for the acquisition of invasive GBS infection and mortality were analysed by univariable and multivariable analysis.ResultsWe collected and analysed data from 74 infants aged < 3 months with invasive GBS infection. Among 67,985 live births, we calculated an incidence of 1.09 per 1000 live births (95%CI:0.81–1.37%); the incidence of Early-onset GBS disease (EOD, n = 65) and Late-onset GBS disease (LOD, n = 9) were 0.96‰(95%CI:0.73–1.19%) and 0.13‰(95%CI:0.04–0.22%), respectively. Overall, pneumonia accounted 63.1% (41/65) of EOD, and sepsis accounted 88.9% (8/9) cases of LOD, respectively. The overall case fatality rate was 8.11% (6/74), including 7.69% (5/65) among cases of EOD and 11.1% (1/9) among cases of LOD. No predictor of mortality was found. Membrane stripping (P = 0.005, aOR: 3.68, 95% CI: 1.48–9.13) and non-resident mother (P < 0.001, aOR: 5.88, 95% CI: 2.36–14.61) were independent risk factors for EOD; no increased risk was found for LOD.ConclusionsThis study demonstrates remarkable country-specific variation in comparison with other countries. Our findings can improve awareness of neonatal GBS infection and lay a cornerstone to ensure accurate representation of the burden.

Newborn Early-Onset Sepsis Guidelines: The Not So Simple Truth.

> The truth is rarely pure and never simple. > —Oscar Wilde How can we criticize a guideline when the proof of its success is abundant and evidence-based? One truth is that the Centers for Disease Control and Prevention (CDC) guidelines for preventing perinatal Group B Streptococcal (GBS) disease have been exceptionally successful. Since the guidelines were first introduced 2 decades ago and have now been widely implemented, there has been a dramatic decline in the incidence of early-onset GBS disease in newborns.1,2 The cornerstones of the CDC guidelines are prenatal GBS screening and intrapartum maternal antibiotics.3 As the authors of the current CDC guideline state, early-onset GBS disease in newborns is now “relatively uncommon.”1 But there is 1 aspect of the CDC guideline that many frontline newborn clinicians find frustrating. Just say the 3 short syllables “chorio” and our blood pressures rise. Intra-amniotic infection (chorioamnionitis) is diagnosed clinically by obstetric clinicians …

The prevalence of asymptomatic group B streptococcal infection and antimicrobial sensitivity pattern among parturients at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: Early-onset Group B Streptococcal (GBS) infection is an important cause of perinatal morbidity and mortality. Policy of active prevention by antepartum screening and treatment is not a popular practice in resource-constrained settings. Objectives: This study determined the prevalence of asymptomatic GBS infection and antimicrobial sensitivity pattern. It also determined the outcome of Intrapartum antimicrobial prophylaxis (IAP). Methodology: It was a prospective and longitudinal study done in Ahmadu Bello University Teaching Hospital, Zaria, between June 2014 and April 2015. Two hundred and twenty consenting pregnant women with gestational ages between 35 and 37 completed weeks were participated in the study. Vagina and rectum were swabbed using different rayon swab sticks. Swabs were placed in Amies, nonnutritive transport medium. Bacteriological procedures to culture GBS and confirmation with biochemical tests and serological test were done. Antibiotic sensitivity pattern was determined. Participants who had GBS rectovaginal colonization had intrapartum antibiotic prophylaxis with penicillin G. All participants were followed up till to a week after birth. Results: Out of the 220 pregnant participants, 19 (8.6%) had GBS rectovaginal colonization. Antibiotic sensitivity pattern revealed that GBS isolates were all sensitive to penicillin, ampicillin, and cefazolin while 4 (21.1%) were resistant to ceftriaxone and 6 (31.6%) were resistant to both erythromycin and clindamycin. None of the isolates were resistant to erythromycin and sensitive to clindamycin or vice versa. Of the 19 participants with GBS rectovaginal colonization, 2 (10.5%) delivered low birth weight baby, but there was no incidence of early-onset GBS disease. Conclusion: The prevalence of GBS rectovaginal colonization in this study is similar to figures from other parts of the country. The GBS sensitivity pattern to penicillin was similar to those reported elsewhere. Fetal outcome following intrapartum antibiotic prophylaxis was good.

Disease Burden of Group B Streptococcus Among Infants in Sub-Saharan Africa: A Systematic Literature Review and Meta-analysis.

Group B streptococcus (GBS) is a leading neonatal sepsis pathogen globally. Investment in GBS disease prevention, such as maternal vaccination, requires evidence of disease burden, particularly in high infant mortality regions like sub-Saharan Africa. We aimed to provide such evidence by conducting a systematic literature review and meta-analysis to estimate maternal colonization proportion, GBS disease incidence and GBS serotype distribution. MEDLINE, MEDLINE in process and Cochrane Library were searched for studies published during 1990-2014, pertaining to sub-Saharan Africa. Eligible studies were used to estimate the proportion of pregnant women colonized with GBS, early-onset GBS disease incidence, late-onset GBS disease incidence and respective serotype distributions. Random effects meta-analysis was conducted to estimate weighted means and confidence intervals (CIs). We identified 17 studies of colonization, 9 of disease incidence, and 6 of serotype distribution meeting inclusion criteria. 21.8% (95% CI: 18.3, 25.5) of expectant women were colonized with GBS. The incidence of early-onset GBS disease was 1.3 per 1000 births (95% CI: 0.81, 1.9), that of late-onset GBS disease 0.73 per 1000 births (95% CI: 0.48, 1.0). The most common disease-causing serotype was 3, followed by 1a. Serotypes 1b, 2 and 5 were next most common in frequency. Despite methodological factors leading to underestimation, GBS disease incidence appears high in sub-Saharan Africa. A small number of GBS serotypes cause almost all disease. GBS disease burden in sub-Saharan Africa suggests that safe, effective and affordable GBS disease prevention is needed.

Infections néonatales bactériennes précoces : évaluation des pratiques professionnelles dans 14 maternités d’Île-de-France en 2013

Early-onset neonatal infection remains a major cause of morbidity and mortality in neonates. Both universal vaginal screening for group-B streptococcus (GBS) and intrapartum antibiotic prophylaxis have decreased the incidence of early-onset GBS disease. Almost 12 years after the implementation of the French recommendations, we assessed the practices around screening, diagnosis, and treatment of early-onset neonatal infection in the Île-de-France region. We conducted a prospective, multicenter, observational study in 14 volunteer maternity wards from 18 to 31 March 2013. All live newborn infants delivered at 35 gestational weeks or more were eligible. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected early-onset neonatal infections. A total of 1194 mothers and 1217 neonates were included. Among the latter, 54% had bacteriological samplings at birth, with at least a gastric aspirate. Bacteriological samples were collected at birth in 85% of cases based on major or minor anamnestic infection criteria defined by the French National Authority for Health in 2002. In addition, 26% of neonates had at least one blood sample taken. Antibiotic treatment was administered in 4% of the infants with cefotaxime administered in two thirds of cases. An update of the French guidelines for the management of early-onset neonatal infections is required in order to improve targeting of newborn infants suspected of having an infection and to optimize the antibiotics administered. Moreover, the role of bacteriological sampling at birth needs to be clarified.

Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines.

Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in NewZealand fiveyears after the publication of national risk-based GBS prevention guidelines. Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life. There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per1000 live births. Ten years after a similar survey and fiveyears after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate.

Role of risk-based approach in the prevention of vertical transmission of neonatal sepsis

Vertical transmission of infections remains a common cause of neonatal morbidity and mortality worldwide. We studied the risk-based approach in preventing the vertical transmission of neonatal sepsis. A prospective case control study of 154 pregnant women with risk factors for vertical transmission of infections (subjects) and 154 pregnant women without the risk factors (control) at University of Ilorin Teaching Hospital, Ilorin from 1st July to 31st December, 2010. After counseling and consent taking, all participants had active management of labour and all subjects had parenteral intrapartum antibiotic prophylaxis with Ampicillin. There was postnatal evaluation of all babies for signs of neonatal sepsis followed by blood culture and treatment of culture positive babies. The outcome measures were signs and symptoms of neonatal sepsis, neonatal positive blood culture and maternal postpartum morbidity. Neonatal sepsis occurred in 16 babies (subjects=11, control=5); three babies had Early Onset Group B Streptococcal Disease (EOGBSD) (subjects=2, control=1; P=0.501) while 13 had non Group B Streptococcal (GBS) infections (subjects=9, control=4; P=0.113); onset of signs and symptoms was < 24hrs in all cases, incidence of EOGBSD were 12.9/1000 (subjects) and 6.5/1000 (controls). Subjects whose babies had sepsis had multiple risk factors; one dose of antibiotics and antibiotics to delivery interval < 2hours. There was no sepsis in babies of mothers who had adequate antibiotic prophylaxis. There was no maternal or neonatal death but 17.5% of subjects had maternal postpartum morbidities. The risk-based approach is a practicable alternative in preventing vertical transmission of neonatal sepsis if antibiotic prophylaxis is adequate before delivery.

Prevention of early-onset Group B Streptococcal disease - the Northern Ireland experience.

To ascertain guideline adherence for prevention of Group B Streptococcal (GBS) neonatal infection and establish prevalence and outcomes in Northern Ireland (NI). Retrospective observational study. Northern Ireland maternity units. Using NI Health Information Systems the following were identified: (1) a cohort of women with one or more risk factors for GBS disease in 2009-2010, (2) all culture-positive cases of GBS in babies aged 0-89 days (2008-2010), (3) stillbirths due to GBS (2009-2010). Information was analysed for a 15% randomised sample of the available cases. Maternal and infant case notes were reviewed for confirmed cases of neonatal early onset GBS (EOGBS) during 2008-2010. Adherence to the 2003 RCOG guideline on prevention of GBS disease (2009-2010). Number of neonatal GBS infections: antenatal risk factors, management and neonatal outcomes (2008-2010). The number of stillbirths related to GBS (2009-2010). Five hundred and seventy-four women had one or more identifiable risk factors for GBS disease; intrapartum antibiotic prophylaxis (IAP) was administered in 42% of cases. Improved administration of IAP was noted in the presence of escalating risk factors. At best, guideline adherence was 50-70%. Forty-three neonates had proven early-onset Group B Streptococcal disease; 55.8% had maternal risk factors. Of the total identified cases, 25.5% received IAP. The total mortality rate was 11.46%. The incidence of EOGBS disease in NI was 0.57/1000 live births. Prevalence of EOGBS is higher in NI than the UK as a whole. Risk factors are present in 55.8% of mothers; IAP does not prevent all cases of EOGBS.

Perinatal Group B Streptococcal Infections: Current Status and Future Directions

Group B Streptococcus (GBS) remains the leading cause of neonatal sepsis and meningitis in the United States, despite a dramatic 80% decline in the incidence of early-onset GBS disease with intrapartum antibiotic prophylaxis (IAP). Perinatal GBS disease persists and the incidence of late-onset GBS disease is unchanged. Maternal immunization with conjugate vaccines for the most prevalent serotypes may have a role in further reducing early-onset disease but should have greater impact on late-onset disease. In addition, it could both reduce the problem of antibiotic resistance and potentially prevent adverse neuro-developmental outcomes. Universal vaccination of pregnant women or adolescent women could confer protection beginning in the third trimester, with transplacental transfer of maternal antibodies, extending protection into early infancy. However, this strategy would be of limited benefit to preterm infants, particularly those born before 32 weeks’ gestation. Universal screening of pregnant women at 35 to 37 weeks’ gestation for GBS colonization and providing IAP remain the mainstays for perinatal disease prevention. In this era of widespread IAP, neonatal management is challenging in the asymptomatic at-risk newborn population. Further research is needed to establish sound diagnostic aids, avoid antibiotic misuse, and prevent serious neurologic sequelae.

Early‐onset group B streptococcal disease following culture‐based screening in Japan: A single center study

We investigated trends in early-onset group B streptococcal disease (EOD) after the introduction of culture-based screening in Japan. A retrospective cohort study examined EOD trends in 9506 pregnancies and 10 715 neonates at our center from 2002 to 2009. EOD occurred in four neonates (4/7332: 0.55/1000 live births). The EOD incidence among infants born to women positive for GBS by screening was 0.90 cases per 1000 live births (1/1107). In contrast, the EOD incidence among infants negative by GBS screening was 0.48 cases per 1000 live births (3/6225). Thus, of the four affected neonates, three had mothers who tested negative on antepartum GBS screening. Two neonates had symptoms of infection during labor and intrapartum antibiotic agents were administered. The other two neonates received no antibiotics because deliveries were uneventful and they were negative on GBS screening. The incidence of EOD is 0.90 cases per 1000 live births among GBS-positive women and 0.48 cases per 1000 live births among GBS-negative women. The results of our study implied that EOD can develop regardless of GBS screening and intrapartum clinical course, although the method of sample collection, indications for antibiotic prophylaxis, and the antibiotics regimen should be considered.

Recommendations for the Prevention of Perinatal Group B Streptococcal (GBS) Disease

The Centers for Disease Control and Prevention (CDC) guidelines for the prevention of perinatal group B streptococcal (GBS) disease were initially published in 1996. The American Academy of Pediatrics (AAP) also published a policy statement on this topic in 1997. In 2002, the CDC published revised guidelines that recommended universal antenatal GBS screening; the AAP endorsed these guidelines and published recommendations based on them in the 2003 Red Book. Since then, the incidence of early-onset GBS disease in neonates has decreased by an estimated 80%. However, in 2010, GBS disease remained the leading cause of early-onset neonatal sepsis. The CDC issued revised guidelines in 2010 based on evaluation of data generated after 2002. These revised and comprehensive guidelines, which have been endorsed by the AAP, reaffirm the major prevention strategy--universal antenatal GBS screening and intrapartum antibiotic prophylaxis for culture-positive and high-risk women--and include new recommendations for laboratory methods for identification of GBS colonization during pregnancy, algorithms for screening and intrapartum prophylaxis for women with preterm labor and premature rupture of membranes, updated prophylaxis recommendations for women with a penicillin allergy, and a revised algorithm for the care of newborn infants. The purpose of this policy statement is to review and discuss the differences between the 2002 and 2010 CDC guidelines that are most relevant for the practice of pediatrics.

Current status and clinical presentations of invasive neonatal Group B streptococcal infections in Korea

Group B streptococcus (GBS) is the most common cause of invasive neonatal infections in developed countries. The incidence of early-onset GBS disease in Korea is known to be much lower than that in other developed countries; however neonatal GBS disease has been frequently reported in recent years in Korea. This retrospective study sought to determine the current status and clinical presentation of neonatal GBS disease in Korea. From January 1996 through December 2005, GBS cases (n= 157) diagnosed in blood, cerebrospinal fluid, or other sterile body fluids among infants <3 months of age from 14 university hospitals in Korea were identified. Age of onset, diagnosis, underlying medical conditions, and outcomes were investigated by reviewing the medical records. A total of 157 cases were identified during the study period. Of the cases, 32 were early-onset disease (EOD) and 125 were late-onset disease (LOD). Twenty-six of the EOD cases had symptoms during the first 24 h after birth. One hundred of the 157 GBS cases were diagnosed as meningitis. The mortality rate of EOD was 20.7%. The case fatality rate of LOD was 7.2% and 25.2% of LOD cases had sequelae. GBS is becoming an important cause of invasive neonatal infections in Korea, with LOD being more common. It may not be currently necessary to adopt the prevention guidelines of perinatal GBS disease in Korea. However, studies of maternal GBS carriage rates and neonatal GBS disease will continue.

The Effect of Universal Maternal Screening on the Incidence of Neonatal Early-Onset Group B Streptococcal Disease

To determine the effect of the revised guidelines on incidence of neonatal early-onset group B streptococcal disease (EoGBS) via retrospective analysis of births in a military population. Information from records of all live births within military hospitals from 1993 to 2007 was obtained. The data were divided into three time frames, representing the evolution of identifying and managing at-risk deliveries for GBS transmission. Incidence of EoGBS decreased from 1.95 to 0.72 per 1000 live births following institution of the 1996 Centers for Disease Control and Prevention recommendations and continued to fall to 0.47 per 1000 since the adoption of universal screening in 2002. Universal culture-based screening is more effective than risk-based screening in preventing EoGBS in term infants. Cases of EoGBS continue to occur, however, at a baseline rate of nearly 0.5 per 1000 births, thus emphasizing the need for rapid diagnostics and ultimately a vaccine.

Institution of universal screening for Group B streptococcus (GBS) from a risk management protocol results in reduction of early‐onset GBS disease in a tertiary obstetric unit

To determine the effect of institution of a universal screening protocol as per CDC 2002 guidelines had on the incidence of early-onset Group B streptococcal (GBS) and non-GBS disease in a tertiary obstetric unit. A prospective study with historical control data reporting the incidence of early-onset GBS and non-GBS disease following institution of a universal screening strategy at John Hunter Hospital, Newcastle, Australia. We compared the incidence of early-onset GBS and non-GBS disease during prescreening (1994-2002) with screening period (2004 to June 2006). The outcome measure was the incidence of early-onset GBS disease. We specifically reported the number of women needed to treat (NNT) with antibiotics and the number of women needed to screen. The incidence of early-onset GBS and non-GBS during the prescreening period was 0.84/1000 and 0.94/1000 live births, respectively. After institution of universal screening, the incidence was 0.00/1000 and 0.72/1000 live births, respectively. This is a statistically significant reduction in early-onset GBS disease by 84% (chi(2) = 5.75; P = 0.016). There was no difference in non-GBS disease (chi2 = 0.14; P = 0.71). The NNT is 1191 and we needed to screen 5704 women to prevent one case of early-onset GBS disease. Screening for GBS rather than by assessing risk factors has significantly reduced the incidence of early-onset GBS disease in our unit. Despite low incidence of early-onset GBS prior to screening period, we still found a significant decrease in early-onset GBS disease after institution of universal screening protocol. These results support the screening-based approach at 34-37 weeks gestation.

PILOT STUDY TO PREVENT EARLY-ONSET GROUP B STREPTOCOCCAL DISEASE IN NEWBORNS

The purpose of this study was to: 1) examine the occurrence of early-onset Group B Streptococcal (GBS) disease in newborns, and 2) describe the relationship between early-onset GBS disease in the newborn and the number of doses of antibiotics the mother received before delivery. Women with a positive Group B Streptococcus screening culture were added to the study based on the inclusion criteria and further grouped based on the number of doses of intrapartum antibiotics received. The mothers and infants in Group 1 received only 1 dose of intrapartum antibiotics; Group 2 received > or =2 doses of intrapartum antibiotics. The sample consisted of a total of 128 women and their infants. This pilot study used a descriptive correlational design. Data were obtained over a 6-month period by a retrospective chart review. Descriptive statistics were used to characterize the demographic data and chi(2) statistical analysis was done to compare the frequency of early-onset GBS disease in each group to determine if there were differences between groups. The Pearson chi(2) value for comparing the 2 groups was 0 with 1 degree of freedom indicating no difference of probability outcome between the 2 groups. There were no differences found in the incidence of early-onset GBS disease in newborns when a GBS positive pregnant woman received 1 or 2 doses of intrapartum antibiotics. These data provide further supporting evidence for the Centers for Disease Control and Prevention's recommendations that were based on the premise that vertical transmission of GBS will be greatly reduced by administration of 1 dose of intrapartum antibiotics at least 4 hours before delivery to expectant mothers.

Early-Onset Group B Streptococcal Disease in the Era of Maternal Screening

Although the wide use of intrapartum antibiotic prophylaxis (IAP) has markedly reduced early-onset neonatal sepsis and meningitis caused by Streptococcus agalactiae (group B streptococcus [GBS]), especially in term infants, GBS disease continues to occur and to cause significant morbidity and mortality. Factors responsible for persistent early-onset GBS disease (EOGBS) were sought in a retrospective review of culture-proved EOGBS seen on a single large maternity service in the years 1997 through 2003. A total of 67,260 infants were live-born during this time. Of 25 cases of EOGBS identified during the period under review, 5 occurred in very-low-birth-weight (VLBW) infants weighing 400 to 1499 g at birth. The overall incidence of EOGBS was 0.37 cases per 1000 live births, and the rate in VLBW infants was 3.3 per 1000 births. Risk estimates for EOGBS had lessened in the overall group and VLBW group since adoption of a risk-based protocol for intrapartum antibiotic prophylaxis (IAP), but no further decline was noted after changing to a screening-based protocol. Seventeen of the 25 cases identified after instituting a screening-based protocol—approximately two thirds—occurred in term infants; there was a single death. Three of the 8 preterm infants died. More than 80% of mothers of term infants had been GBS-negative when screened. A majority of these mothers had intrapartum risk factors for neonatal infection but did not receive antibiotics before delivery. Only one of the 25 women in the study received adequate IAP. In 4 instances, either documented GBS colonization went unrecognized or an infant at risk of sepsis was not evaluated. Five of 25 isolates (20%) were resistant to clindamycin and/or erythromycin, and 5 others were partially resistant to erythromycin or clindamycin. None of the invasive isolates were resistant to penicillin, ampicillin, cephalosporin, or vancomycin. Screening for GBS disease has substantially lowered the overall rate of neonatal EOGBS. In the present review, a majority of cases occurred in infants whose mothers had been screen-negative for GBS colonization. Two measures are important: prompt IAP for women with clinical evidence of chorioamnionitis regardless of the screening results and evaluation of normal-appearing infants for possible sepsis.

Invasive group B streptococcal infections in Finland: a population-based study.

We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2–3.0/100,000 population). We found 32–38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6–0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease.