Risk Factors for Early-onset Group B Streptococcal Sepsis: Estimation of Odds Ratios by Critical Literature Review

Abstract

h Mothers with GBS bacteriuria during pregnancy, with another child with GBS disease, or with chorioamnionitis should receive empirical intrapartum antibiotic treatment. Their infants should have complete diagnostic evaluations and receive empirical treatment until infection is excluded by observation and negative cultures because of their particularly high risk for EOGBS infection. Either screening with cultures at 28 weeks gestation or identification of clinical risk factors, ie, PROM, intrapartum fever, or prematurity, may identify parturients whose infants include 65% of those with EOGBS infection. Intrapartum screening using the Strep B OIA rapid test identifies more at-risk infants (75%) than any other method. These risk identifiers may permit judicious selection of patients for prophylactic interventions.

The changing spectrum of neonatal infectious disease

“…These include a maternal fever >38 1C, chorioamnionitis, prolonged or preterm ROM, poor prenatal care, poor maternal nutrition, a history of recurrent abortion, low birth weight, maternal substance abuse, difficulty in delivery, birth asphyxia and meconium staining. 17,18 Knowledge of the risks and timing of exposure to GBS that would result in early-onset infection has allowed for recommendations for interventions that have resulted in the successful decrease of early-onset GBS disease. After the implementation of the American College of Obstetricians and Gynecologists and Centers for Disease Control and Prevention recommendations for maternal screening for colonization and intrapartum antibiotic prophylaxis during labor for women with known GBS colonization or other risk factors, the occurrence of early-onset GBS disease was dramatically decreased.…”

Interpreting Complete Blood Counts Soon After Birth in Newborns at Risk for Sepsis

“…As a result, odds ratios reported in Table 1 should not be used to infer risk relationships in the general population of infants. For example, although preterm delivery is a risk factor for infection in newborns, [22][23][24] the fact that preterm infants were more likely to be selected for CBCs and blood cultures masked the relationship between gestational age and infection in this study, as evidenced an the odds ratio of 0.61 for infants with a gestational age of 34 to weeks compared with infants with a gestational age of ≥39 weeks.…”

Early-Onset Neonatal Group B Streptococcal Sepsis: Intrapartum Antibiotic Prophylaxis in the Clinical Setting

“…In this regard, the use of Strep B optical immunoassay appears to be promising. 6,14 The number of infected infants born to mothers with``unknown'' status highlights the importance of considering such mothers for intrapartum antibiotic prophylaxis in the presence of known risk factors for infection. Indeed, when we reviewed these infants' data to see if their mothers would have qualified for intrapartum antibiotic prophylaxis based on the CDC consensus guidelines that were published in 1996, 13 excluding GBS colonization as a risk factor, all but one of the six mothers with unknown status would have qualified for intrapartum antibiotics.…”

“…Multiple births, GBS bacteriuria during pregnancy, and birth weight less than 2500 g have also been cited by some as additional risk factors for infection. 6,7,11,13 The ultimate test of the effectiveness of these guidelines is, of course, how they are applied in the practice setting and whether they affect the incidence and severity of GBS disease.…”