Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy

Sithembiso Velaphi, Jane D. Siegel, George D. Wendel, Nancy Cushion, Walid M. Eid, Pablo J. Sánchez

Research output: Contribution to journalArticle

50 Scopus citations

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 ≤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%1). 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 ≥2 doses of intrapartum chemoprophylaxis, and among those with intrapartum fever, 25% received ≥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.

Original languageEnglish (US)
Pages (from-to)541-547
Number of pages7
JournalPediatrics
Volume111
Issue number3
DOIs
StatePublished - Mar 1 2003

Keywords

  • Ampicillin
  • Chemoprophylaxis
  • Group B streptococcus
  • Neonatal sepsis
  • Penicillin G

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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