| Title | Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy. | | Author(s) | Velaphi S, Siegel JD, Wendel GD, Cushion N, Eid WM, Sánchez PJ | | Institution | Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 75390-9063, USA. | | Source | Pediatrics 2003 Mar; 111(3):541-7. | | MeSH | Ampicillin
Antibiotic Prophylaxis
Disease Transmission, Vertical
Female
Fever
Humans
Infant, Newborn
Penicillins
Pregnancy
Pregnancy Complications, Infectious
Questionnaires
Sepsis
Severity of Illness Index
Streptococcal Infections
Streptococcus agalactiae
Treatment Failure
| | Abstract | OBJECTIVE: In January 1995, a combined maternal and neonatal protocol for prevention of early-onset group B streptococcal (GBS) infection was implemented that consisted of a risk factor-based approach for maternal intrapartum chemoprophylaxis using ampicillin combined with a single intramuscular dose of penicillin given to all newborns within 1 hour of delivery. The objective of this study was to review the cases of early-onset GBS infections that occurred from 1995 to 1999 to identify factors associated with their continued occurrence despite implementation of a GBS chemoprophylaxis protocol.
METHODS: Infants <or=72 hours of age with early-onset GBS infection born at Parkland Memorial Hospital in Dallas from January 1995 to December 1999 were identified through a prospective laboratory-based surveillance system. Maternal and infant medical records were reviewed for clinical and demographic data.
RESULTS: There were 32 cases (0.47/1000 live births) of early-onset GBS infection for the 5-year period. This represented a 76% reduction compared with the rate from 1986 to 1994 (1.95/1000), when there was no protocol for GBS chemoprophylaxis. Thirteen cases (41%) did not have any identifiable maternal risk factor. Of the 19 cases (59%) with risk factors, maternal intrapartum fever was the most frequent (15 [79%]), followed by prematurity (6 [32%]) and prolonged rupture of membranes (6 [32%]). Among the 19 mothers with risk factors, 15 (79%) mothers received intrapartum chemoprophylaxis, and 12 (80%) of the 15 mothers had intrapartum fever. Only 33% of mothers with risk factors received >or=2 doses of intrapartum chemoprophylaxis, and among those with intrapartum fever, 25% received >or=2 doses. None of the 32 infants with early-onset GBS infection received the combination of intrapartum ampicillin and postnatal penicillin.
CONCLUSIONS: A combined obstetric and neonatal chemoprophylaxis protocol significantly reduced early-onset GBS infection. Maternal intrapartum fever was the most frequent risk factor associated with failure of chemoprophylaxis. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 12612234 |
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