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Neonatal group B streptococcal infection in a managed care population. Perinatal Group B Streptococcal Infection
T A Lieu1, J C Mohle-Boetani, G T Ray
1Division of Research, The Permanente Medical Group, Oakland, California 94611, USA. tal@dor.kaiser.org
Insights
Implementing risk factor-based protocols for intrapartum antibiotics shows promise in reducing early-onset neonatal group B streptococcal (GBS) disease, but adherence remains a challenge.
Area of Science:
- Neonatal infectious diseases
- Obstetrics and Gynecology
- Public Health
Background:
- Early-onset neonatal group B streptococcal (GBS) disease poses a significant risk to newborns.
- Identifying and managing labor risk factors is crucial for preventing GBS transmission.
Purpose of the Study:
- To determine the incidence of early-onset neonatal GBS disease.
- To evaluate the sensitivity and prevalence of labor risk factors.
- To assess adherence to intrapartum antibiotic protocols and their impact on GBS outcomes.
Main Methods:
- Retrospective study of 79,940 live births in a health maintenance organization from 1989-1995.
- Analysis of computerized databases and chart reviews.
- Comparison of GBS incidence before and after adoption of intrapartum antibiotic protocols at two hospitals.
Main Results:
- Higher GBS incidence in preterm infants (3.1/1000) vs. term infants (0.9/1000).
- Before protocol adoption, 68% of GBS cases had mothers with labor risk factors.
- Protocols reduced GBS incidence from 1.3 to 0.8 per 1000 births (P=.08) at adopting hospitals.
Conclusions:
- Risk factor-based protocols can potentially reduce neonatal GBS disease.
- Improved clinical strategies are necessary to enhance adherence to intrapartum antibiotic protocols.
- Further research is needed to optimize GBS prevention strategies.
Objective:
In a health maintenance organization population, we determined the incidence of early-onset (at less than or equal to 7 days) neonatal group B streptococcal (GBS) disease, the sensitivity and prevalence of labor risk factors, the adherence to a protocol for intrapartum antibiotics, and the costs for care of and outcomes of affected infants.
Methods:
Mothers and infants at four health maintenance organization hospitals in northern California in 1989 to 1995 were studied retrospectively using computerized databases and chart review. In 1994, two of the four hospitals had adopted protocols similar to the ACOG recommendations for intrapartum antibiotics for women with labor risk factors (preterm, temperature 100.4F or higher, or rupture of membranes (ROM) 18 hours or more).
Results:
Among the 79,940 live births, the incidence of early-onset neonatal GBS infection was higher among preterm than among term infants (3.1 compared with 0.9 per 1000). Before protocol adoption, 68% of 65 infants with GBS had mothers with labor risk factors. Approximately 18% of all mothers had labor risk factors: 7.7% had preterm delivery, and 10.6% had term delivery with fever and/or ROM 18 hours or more. At the two hospitals that adopted GBS protocols, GBS incidence was reduced from 1.3 per 1000 in the preprotocol period to 0.8 per 1000 in the postprotocol period (P=.08). Six cases of neonatal GBS occurred after protocol adoption. Of these, four were not preventable under the protocol and two might have been preventable if protocol had been followed. Three of the 19 preterm infants with group B streptococcal disease died.
Conclusion:
Risk factor-based protocols hold some promise to reduce GBS disease, but clinical strategies to promote protocol adherence are needed.