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Prenatal screening for group B Streptococcus. II. Impact of antepartum screening and prophylaxis on neonatal care
B M Mercer1, R D Ramsey, B M Sibai
1Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
Insights
Pediatricians often provide antimicrobial prophylaxis to preterm infants, influenced by maternal factors like fever and group B Streptococcus carriage. This practice may increase neonatal treatment duration and warrants careful consideration of efficacy and risks.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Infectious Disease
Background:
- Antimicrobial prophylaxis is a key strategy in preventing neonatal infections.
- Practices vary regarding its use in preterm and low-birth-weight infants.
- Factors like intrapartum events and maternal carriage influence neonatal treatment decisions.
Purpose of the Study:
- To evaluate current antimicrobial prophylaxis practices for preterm and low-birth-weight infants.
- To determine the impact of intrapartum fever, group B Streptococcus (GBS) carriage, intrapartum antimicrobial therapy, and duration of membrane rupture on neonatal therapy.
Main Methods:
- A survey was distributed to 1356 members of the American Academy of Pediatrics.
- Respondents reported their practices concerning neonatal screening and antimicrobial prophylaxis.
- Questions focused on how specific maternal and intrapartum factors influence neonatal treatment decisions.
Main Results:
- 33.7% of pediatricians routinely give asymptomatic preterm neonates antimicrobial prophylaxis.
- Intrapartum fever significantly increases the likelihood of neonatal prophylaxis, regardless of intrapartum therapy.
- Knowledge of maternal GBS carriage increases neonatal treatment incidence and duration, with some pediatricians treating term neonates without other risk factors.
Conclusions:
- Antepartum screening and intrapartum prophylaxis for GBS may increase the incidence and duration of neonatal treatment.
- The efficacy, cost, and risks of widespread screening and treatment programs require careful evaluation.
- Establishing a standard of care for neonatal antimicrobial prophylaxis necessitates consideration of these factors.
Objectives:
Our purpose was to evaluate the current practice of antimicrobial prophylaxis of preterm and low-birth-weight infants and to determine the impact of intrapartum fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and duration of membrane rupture on neonatal therapy.
Study Design:
A total of 1356 members of the American Academy of Pediatrics were asked their practice regarding neonatal screening and antimicrobial prophylaxis. Respondents were asked to define how maternal fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and prolonged membrane rupture would affect their decisions regarding neonatal therapy.
Results:
A total of 982 responses were obtained (72.4%). Routine antimicrobial prophylaxis is given to asymptomatic preterm neonates by 33.7% of pediatricians. Prophylaxis is inconsistently given at 32 to 36 weeks but is nearly universal after intrapartum fever, regardless of intrapartum therapy. If empiric intrapartum prophylaxis was given before a preterm birth, both the incidence (47.1% vs 29.1%) and frequency of prolonged neonatal therapy (30.1% vs 17.4% > or = 7 days) would be increased. Knowledge of maternal group B Streptococcus carriage would lead to a 2.6-fold increase in treatment (75.1% vs 29.1%) and 1.8-fold increase in the incidence of prolonged therapy of preterm infants (30.9% vs 17.4%), with 45.3% giving antibiotics for > or = 1 week if intrapartum treatment had been instituted. Surprisingly, 18% of pediatricians would treat term neonates without any risk factors other than maternal group B streptococcal carriage, and 32.7% would continue treatment for > or = 7 days. The majority of pediatricians (82.6%) felt that intrapartum prophylaxis would reduce early-onset group B streptococcal sepsis, but only 46.0% felt overall neonatal sepsis would be decreased by such therapy.
Conclusions:
Antepartum screening and intrapartum prophylaxis against group B Streptococcus by obstetricians may lead to an increased incidence and duration of treatment of preterm and term neonates by the pediatrician. The efficacy, cost, and risk of such treatment in broadly applied screening and treatment programs should be considered before a standard of care is established.