The capture rate of at-risk term newborns for early-onset group B streptococcal sepsis determined by a risk factor approach
Related Experiment Video
Updated: Oct 11, 2026
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
C V Towers1, K Suriano, T Asrat
1University of California, Irvine, USA.
Insights
The current risk factor strategy for preventing neonatal group B streptococcal sepsis captures less than half of at-risk term newborns. This highlights a significant gap in protecting neonates from this serious infection.
Area of Science:
- Neonatal Health
- Infectious Disease Prevention
- Obstetrics and Gynecology
Background:
- Current guidelines recommend intrapartum antibiotic chemoprophylaxis for preventing early-onset neonatal group B streptococcal sepsis.
- Two strategies exist: universal treatment for positive cultures at 35-37 weeks or risk-factor-based treatment.
- The risk-factor strategy's effectiveness in capturing at-risk neonates is debated, particularly for term births.
Purpose of the Study:
- To prospectively evaluate the effectiveness of current risk-factor criteria in identifying neonates with early-onset group B streptococcal sepsis.
- To determine the percentage of term newborns with sepsis who had identifiable intrapartum risk factors.
Main Methods:
- A prospective study conducted from July 1, 1987, to December 31, 1996.
- Analysis of all cases of blood culture-proven early-onset neonatal group B streptococcal sepsis.
- Detailed assessment of intrapartum risk factors (membrane rupture duration, maternal temperature) for each case.
Main Results:
- 49 cases of early-onset group B streptococcal sepsis occurred in 46,959 deliveries.
- Of 40 term newborns with sepsis, only 12 (30%) presented with defined intrapartum risk factors (prolonged rupture or fever).
- 18% of affected newborns were preterm (<37 weeks gestation).
Conclusions:
- The current risk-factor-based approach would identify less than 50% of term newborns who develop early-onset group B streptococcal sepsis.
- Existing guidelines may not adequately capture all neonates at risk for this severe infection.
- Further research is needed to improve the sensitivity of risk-factor assessment for neonatal sepsis prevention.
Objective:
Currently, the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommend that health care providers for pregnant women implement 1 of 2 strategies for the potential prevention of early-onset neonatal group B streptococcal sepsis. Both algorithms recommend intrapartum antibiotic chemoprophylaxis for patients delivered of their neonates at <37 weeks' gestation. The basic difference lies in the management of the term pregnancy. One protocol suggests treatment of all patients with term pregnancies with a positive culture for group B Streptococcus obtained at 35 to 37 weeks' gestation. The second approach recommends treatment on the basis of risk factors of membrane rupture of >/=18 hours' duration or intrapartum temperature of >/=38 degrees C. The capture rate of at-risk neonates determined by the risk factor strategy is quoted as being approximately 70%; however, the basis for this percentage was from studies that used slightly different definitions than the current guidelines and never separated the term from the preterm newborn. Our objective was to prospectively collect every case of blood culture-proven early-onset neonatal group B streptococcal sepsis and determine whether risk factors, as currently defined, were present that might have warranted maternal intrapartum antibiotic chemoprophylaxis.
Study Design:
A prospective study was initiated on July 1, 1987, and completed on December 31, 1996. Every patient that was delivered of a neonate in whom early-onset group B streptococcal sepsis developed was analyzed in detail for possible intrapartum risk factors.
Results:
A total of 49 cases of early-onset group B streptococcal sepsis occurred in 46,959 deliveries. Of these 49 newborns, 9 (18%) were delivered at <37 weeks' gestation. The remaining 40 newborns were delivered at term, and only 12 (30%) were delivered with an intrapartum risk factor of either membrane rupture of >/=18 hours' duration or temperature of >/=38 degrees C or both.
Conclusions:
On the basis of the data from this study and the current literature, the risk factor approach with the current guideline recommendations would capture <50% of the term newborns in whom sepsis develops.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...
01:30Development of Human Microbiota
01:28Development of the Oral Microbiota
01:26Bacterial Meningitis II: Pathophysiology