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Updated: Apr 7, 2026
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines
Brian A Darlow1, Lesley Voss2, Diana R Lennon3,4
1Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand.
Insights
Neonatal group B streptococcus (GBS) sepsis incidence halved in New Zealand after risk-based guidelines. Further reductions are possible, highlighting the need for improved intrapartum antibiotic use for GBS prevention.
Area of Science:
- Neonatal infections
- Public health surveillance
- Infectious disease epidemiology
Background:
- Neonatal group B streptococcus (GBS) infection is a significant cause of infant mortality.
- Current GBS prevention strategies involve intrapartum antibiotics, with varying recommendations for antenatal screening versus risk factor-based approaches.
- National risk-based GBS prevention guidelines were implemented in New Zealand.
Purpose of the Study:
- To determine the incidence of early-onset GBS sepsis in New Zealand.
- To evaluate the impact of national risk-based GBS prevention guidelines implemented five years prior.
- To assess opportunities for further reduction in GBS sepsis rates.
Main Methods:
- Prospective surveillance of early-onset GBS sepsis (within 48 hours of birth) from April 2009 to March 2011.
- Data collected through the New Zealand Paediatric Surveillance Unit.
- Retrospective review of hospital laboratory databases and sensitivity analysis to estimate national incidence.
Main Results:
- An incidence rate of 0.23 per 1000 live births for early-onset GBS sepsis was observed (0.26 per 1000 with sensitivity analysis).
- Three infant deaths (10.3%) occurred.
- Maternal risk factors for intrapartum antibiotics were present in 55% of cases, but only 31% received the intervention.
Conclusions:
- The incidence of early-onset GBS disease in New Zealand has decreased by over 50% since previous surveys and guideline implementation.
- Despite reductions, opportunities exist to further lower the rate of GBS sepsis.
- Optimizing the use of intrapartum antibiotics based on identified risk factors is crucial for enhanced GBS prevention.
Background:
Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in New Zealand five years after the publication of national risk-based GBS prevention guidelines.
Materials And Methods:
Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48 h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life.
Results:
There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per 1000 live births.
Conclusions:
Ten years after a similar survey and five years after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate.
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