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Am J Perinatol 2002; 19(6): 341-348
DOI: 10.1055/s-2002-34464
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Impact of Different Prevention Strategies on Neonatal Group B Streptococcal Disease

Patrizia Vergani1 , Luisa Patanè1 , Carla Colombo2 , Cesarina Borroni2 , Giuseppe Giltri3 , Alessandro Ghidini4
  • 1Divisioni di Ostetricia e Ginecologia, Ospedale San Gerardo, University of Milano-Bicocca, Monza, Italy
  • 2Patologia Neonatale, Ospedale San Gerardo, University of Milano-Bicocca, Monza, Italy; e
  • 3Laboratorio di Microbiologia, Ospedale San Gerardo, University of Milano-Bicocca, Monza, Italy
  • 4Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, Virginia
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Publication Date:
01 October 2002 (online)

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ABSTRACT

The objective of this paper is to evaluate the effect of different prevention strategies on the rate of early-onset neonatal group B streptococcus (GBS) disease and mortality. We compared the neonatal mortality and morbidity rates associated with early-onset GBS disease in three periods characterized by different prevention strategies, including no screening for GBS during pregnancy and no standardized chemoprophylaxis (1/1987 to 12/1990), antibiotic prophylaxis only with risk factors for GBS (1/1991 to 12/1994), and universal screening for GBS with rectovaginal cultures and chemoprophylaxis for women with positive results or risk factors (1/1995 to 12/1999). Statistical analysis included Fisher's exact test and Chi-square, with a two-tailed p <0.05 considered significant. The yearly prevalence of positive GBS cultures was similar throughout the screening period (mean 18%, range 16 to 19%). Compared with the no prophylaxis group (rate = 4/8,573), introduction of universal screening (rate = 0/13,754, p = 0.02) but not of prophylaxis for risk factors alone (rate = 1/10,303, p = 0.18) significantly decreased the occurrence of GBS-specific neonatal mortality. Universal screening decreased, though not significantly, the GBS-specific neonatal morbidity rates compared with a policy based on risk factors alone (0.4/1000 vs. 0.8/1000, p = 0.29). Our study had a power to detect a 0.7/1000 difference in the rate of specific morbidity between the two chemoprophylaxis policies (α = 0.05, β= 0.80). Intrapartum prophylaxis for GBS, using universal screening or risk factors, is associated with a significant reduction in the specific neonatal mortality rate compared with no prophylaxis. Universal screening for GBS leads to a decrease in specific GBS morbidity compared with screening using risk factors alone.

KEYWORDS

Group B streptococcus - neonatal sepsis - antibiotic prophylaxis - screening - risk-based approach

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