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Impact of different prevention strategies on neonatal group B streptococcal disease
Patrizia Vergani1, Luisa Patanè, Carla Colombo
1Divisioni di Ostetricia e Ginecologia, Ospedale San Gerardo, University of Milano-Bicocca, Monza, Italy.
Insights
Universal screening for group B streptococcus (GBS) significantly reduced neonatal mortality. Universal screening also decreased GBS-related morbidity compared to risk-factor-based prophylaxis.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Infectious Disease Prevention
Background:
- Group B Streptococcus (GBS) remains a significant cause of neonatal disease and mortality.
- Prevention strategies for early-onset GBS disease have evolved over time.
- Evaluating the impact of these strategies is crucial for public health.
Purpose of the Study:
- To assess the effectiveness of different prevention strategies on neonatal GBS disease and mortality.
- To compare neonatal outcomes under three distinct GBS prevention policies.
- To determine the impact of universal screening versus risk-factor-based prophylaxis.
Main Methods:
- Retrospective comparison of neonatal mortality and morbidity rates over three periods with different GBS prevention strategies.
- Data collected from 1987 to 1999, encompassing no prophylaxis, risk-factor-based prophylaxis, and universal screening.
- Statistical analysis using Fisher's exact test and Chi-square, with significance set at p <0.05.
Main Results:
- Universal GBS screening significantly decreased GBS-specific neonatal mortality compared to no prophylaxis (p=0.02).
- Risk-factor-based prophylaxis alone did not significantly reduce GBS-specific neonatal mortality (p=0.18).
- Universal screening showed a trend towards decreased GBS-specific neonatal morbidity compared to risk-factor-based prophylaxis (0.4/1000 vs. 0.8/1000, p=0.29).
Conclusions:
- Intrapartum prophylaxis for GBS, whether through universal screening or risk-factor-based approaches, significantly reduces neonatal mortality.
- Universal GBS screening is more effective in reducing neonatal mortality than risk-factor-based prophylaxis alone.
- Universal screening demonstrates a potential benefit in decreasing GBS-specific neonatal morbidity.
Abstract:
The objective of this paper is to evaluate the effect of different prevention strategies on the rate of early-onset neonatal group B streptococcus (GBS) disease and mortality. We compared the neonatal mortality and morbidity rates associated with early-onset GBS disease in three periods characterized by different prevention strategies, including no screening for GBS during pregnancy and no standardized chemoprophylaxis (1/1987 to 12/1990), antibiotic prophylaxis only with risk factors for GBS (1/1991 to 12/1994), and universal screening for GBS with rectovaginal cultures and chemoprophylaxis for women with positive results or risk factors (1/1995 to 12/1999). Statistical analysis included Fisher's exact test and Chi-square, with a two-tailed p <0.05 considered significant. The yearly prevalence of positive GBS cultures was similar throughout the screening period (mean 18%, range 16 to 19%). Compared with the no prophylaxis group (rate = 4/8,573), introduction of universal screening (rate = 0/13,754, p = 0.02) but not of prophylaxis for risk factors alone (rate = 1/10,303, p = 0.18) significantly decreased the occurrence of GBS-specific neonatal mortality. Universal screening decreased, though not significantly, the GBS-specific neonatal morbidity rates compared with a policy based on risk factors alone (0.4/1000 vs. 0.8/1000, p = 0.29). Our study had a power to detect a 0.7/1000 difference in the rate of specific morbidity between the two chemoprophylaxis policies (alpha = 0.05, beta= 0.80). Intrapartum prophylaxis for GBS, using universal screening or risk factors, is associated with a significant reduction in the specific neonatal mortality rate compared with no prophylaxis. Universal screening for GBS leads to a decrease in specific GBS morbidity compared with screening using risk factors alone.