http://bmj.com/cgi/content/abstract/325/7359/308
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under which this article appears: Pregnancy
Other
Infectious Diseases Paediatric
Neonates
Other
Pediatrics |
Sam Oddie
Newcastle Neonatal Service, Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
Correspondence to: S Oddie s.j.oddie@ncl.ac.uk
Objectives: To quantify risk factors for and the prevalence
of early onset group B streptococcal sepsis in neonates in a geographically
defined population.
Design: Cases were collected prospectively for two years from
April 1998 and compared with four controls each, matched for time and
place of delivery.
Setting: The former Northern health region of the United
Kingdom.
Participants: Infants infected with group B streptococcus in
the first week of life.
Results: The prevalence of early onset group B streptococcal
sepsis was 0.57 per 1000 live births. Premature infants comprised 38%
of all cases and 83% of the deaths. Prematurity (odds ratio 10.4, 95%
confidence interval 3.9 to 27.6), rupture of the membranes more than
18 hours before delivery (25.8, 10.2 to 64.8), rupture of the
membranes before the onset of labour (11.1, 4.8 to 25.9), and
intrapartum fever (10.0, 2.4 to 40.8) were significant risk factors
for infection. Had the interim recommendations on best practice
issued by the Group B Streptococcus Working Group of the Public
Health Laboratory Service been uniformly applied to the fetuses alive
at the onset of labour, 29 of 37 (78%) might have been given
antibiotic prophylaxis during labour. At least 23 of these 29 (79%)
could have had antibiotics for four hours or more before delivery. To
achieve this, 16% of all women would have been given antibiotics
during labour.
Conclusions: Early onset group B streptococcal sepsis remains
an important problem in the United Kingdom. Prevention based on risk
factors might reduce the prevalence at the cost of treating many
women with risk factors. Using rupture of the membranes before the
onset of labour as a risk factor might be expected to improve the
success of guidelines for prophylaxis.
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What is already known on this topic The prevalence of early onset group B streptococcal sepsis in the United Kingdom is not well defined Data from the United States and Australia show that the prevalence may be reduced drastically by using selective antibiotic prophylaxis during labour What this study adds Rupture of the membranes before the onset of labour should be considered as an important risk factor and might identify potential cases at an earlier stage Current prophylactic guidelines might prevent or ameliorate three quarters of all cases of infection at the cost of giving antibiotics to 16% of all women in labour |
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