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Comparison of two prevention strategies for neonatal group B streptococcal disease
1Department of Family and Community Medicine, Lancaster General Hospital, PA 17604, USA.
Insights
Few women received recommended intrapartum antibiotics for neonatal group B streptococcal disease prevention. Prenatal screening cultures were feasible, with comparable costs and length of stay between screening and risk factor strategies.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Disease Prevention
Background:
- Neonatal group B streptococcal (GBS) disease is a significant cause of sepsis in newborns, with over 2,000 cases annually.
- The Centers for Disease Control and Prevention (CDC) recommends two strategies for GBS infection prevention.
- Limited comparative data exist for these strategies regarding antibiotic administration, feasibility, newborn evaluation, and costs.
Purpose of the Study:
- To compare the effectiveness and feasibility of two GBS prevention strategies: screening versus risk factor-based.
- To evaluate intrapartum antibiotic administration, protocol compliance, newborn laboratory testing, and length of stay.
Main Methods:
- A comparative study of 347 mother-infant pairs was conducted in a family practice residency maternity service.
- Women were managed under either the screening strategy or the risk factor strategy during two distinct study periods.
- Data collected included intrapartum antibiotic use, protocol compliance, newborn laboratory evaluation, and maternal-newborn length of stay.
Main Results:
- Only 28% of women in the screening group and 47% in the risk factor group received adequate intrapartum antibiotics.
- Prenatal screening cultures were performed appropriately in 91% of women in the screening group.
- Newborns in the screening group showed an increased risk for complete blood count testing (OR = 1.35), with no significant differences in length of stay.
Conclusions:
- A minority of women received the recommended intrapartum antibiotic doses regardless of the strategy used.
- The screening strategy demonstrated high feasibility for obtaining prenatal cultures.
- While newborn laboratory testing increased with screening, overall costs and length of stay remained comparable between the two strategies.
Background:
Neonatal group B streptococcal disease is a serious infection, causing more than 2,000 cases of sepsis annually. The Centers for Disease Control and Prevention has recommended two alternative strategies to prevent infection, but few data directly compare the two in terms of intrapartum antibiotic administration, protocol feasibility, newborn laboratory evaluation, and costs.
Methods:
We collected data on intrapartum antibiotic administration, protocol compliance, newborn laboratory evaluation, and maternal-newborn length of stay for 347 mother-infant pairs in a family practice residency maternity service. During the first study period, laboring women were managed under the screening strategy, and during the second study period, laboring women were managed under the risk factor strategy.
Results:
Of those women who qualified for antibiotic prophylaxis, only 28% of women in the screening group and 47% of women in the risk factor group actually received the recommended two or more doses of intrapartum antibiotics. Ninety-one percent of women in the screening group had prenatal cultures done appropriately. Newborns in the screening group had an increased risk of having a complete blood count (OR = 1.35, 95% CI 1.01, 1.80). There was no difference between groups in maternal or newborn length of stay.
Conclusions:
A minority of laboring women in either strategy received the recommended doses of intrapartum antibiotics. Feasibility of obtaining prenatal screening cultures is high. Although newborn laboratory testing increased with the screening strategy, overall costs and length of stay were comparable.