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Prevention of group B Streptococcus infection in neonates
1Cook Children's Medical Center, Fort Worth, TX 76104, USA.
Insights
Group B Streptococcus (GBS) causes serious neonatal infections. Intrapartum antimicrobial chemoprophylaxis can prevent most early-onset GBS infections in newborns, reducing infant morbidity and mortality.
Area of Science:
- Neonatal infections
- Obstetrics
- Epidemiology
Background:
- Group B Streptococcus (GBS) remains a significant cause of serious neonatal infections.
- Many pregnant women are colonized with GBS, posing a risk to their infants.
Purpose of the Study:
- To review the epidemiology, risk factors, and clinical manifestations of GBS infection in neonates.
- To evaluate chemoprophylaxis and immunoprophylaxis for GBS prevention.
- To outline current recommendations for preventing neonatal GBS disease.
Main Methods:
- Literature search of MEDLINE (1976-1997).
- Review of epidemiology, risk factors, clinical manifestations, and prevention strategies for GBS.
Main Results:
- Intrapartum antimicrobial chemoprophylaxis is effective in preventing most early-onset GBS infections.
- Prevention programs are more cost-effective than treatment, reducing infant morbidity and mortality.
- The CDC has recommended two strategies for intrapartum antibiotic administration to at-risk pregnant women.
Conclusions:
- GBS colonization during pregnancy is common and can lead to infant infection.
- Despite published prevention strategies for over a decade, implementation remains inconsistent.
- Adhering to CDC-recommended strategies can prevent the majority of neonatal GBS infections.
Objective:
To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention.
Data Sources And Study Selection:
MEDLINE searchers (1976-1997) of the English-language literature.
Data Synthesis:
Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection. Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis. Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease. Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US. To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies. In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation. The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor.
Conclusions:
GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant. Prevention strategies have been published for more than 10 years without successful implementation. Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.