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Impact of maternal group B streptococcal screening on pediatric management in full-term newborns
M Peralta-Carcelen1, C A Fargason, S P Cliver
1Department of Pediatrics, University of Alabama at Birmingham, USA.
Background:
The American Academy of Pediatrics strategy to prevent early-onset neonatal sepsis with group B streptococcus (GBS) relies on maternal antepartum GBS cultures, while the American College of Obstetrics and Gynecology strategy does not.
Objective:
To evaluate the impact of the 2 strategies on the care of asymptomatic full-term newborns.
Design/Setting:
Self-administered survey mailed to a national random sample of US pediatricians who were members of the American Academy of Pediatrics.
Participants:
A total of 461 members of the American Academy of Pediatrics who routinely care for newborns.
Main Outcome Measure:
Self-report of diagnostic and treatment strategies for asymptomatic full-term newborns who were born under different clinical scenarios. Maternal risk factors, antepartum maternal GBS screening status, and maternal treatment with intrapartum antibiotics were varied across the scenarios.
Results:
Pediatricians treating asymptomatic full-term newborns born to risk factor-negative mothers reported ordering tests (63.3% in GBS-positive cases vs 6.7% with GBS unknown; P = .001) and antibiotics (21.5% in GBS-positive cases vs 0.9% with GBS unknown; P = .001) more frequently when presented with a positive maternal GBS screening result. Maternal intrapartum treatment had little impact on pediatric practice when risk factors were absent. In risk factor-positive mothers, pediatricians reported an increase in their antibiotic usage in response to a positive maternal GBS screen (61.8% in GBS-positive cases vs 36.9% with GBS unknown; P = .001). In risk factor-positive mothers with unknown results of GBS screening, use of intrapartum antibiotics increased the number of pediatricians who reported that they would prescribe antibiotic therapy.
Conclusions:
Obstetrical strategies to decrease the risk of neonatal GBS sepsis increase pediatric services provided to full-term healthy newborns. This increase in services by pediatric practices is likely to be greater with the screening-based strategy recommended by the American Academy of Pediatrics.