Early-onset group B Streptococcus sepsis in high risk neonates born after prolonged rupture of membranes

According to the U.S. Centers for Disease Control guidelines, prolonged rupture of membranes mandates intrapartum antimicrobial prophylaxis for group B Streptococcus whenever maternal GBS status is unknown. To evaluate the local incidence, early detection and outcome of early-onset GBS sepsis in neo...

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Bibliographic Details
Published in:The Israel Medical Association journal 2009-01, Vol.11 (1), p.34-38
Main Authors: Makhoul, Imad R, Sprecher, Hannah, Sawaid, Raneen, Jakobi, Peter, Smolkin, Tatiana, Sujov, Polo, Kassis, Imad, Blazer, Shraga
Format: Article
Language:English
Subjects:
Age Factors
Antibiotic Prophylaxis
Bacteremia - diagnosis
Bacteremia - etiology
Bacteremia - microbiology
Biomarkers - blood
Blood Cell Count
C-Reactive Protein - metabolism
Female
Fetal Membranes, Premature Rupture - physiopathology
Gene Amplification
Humans
Infant
Infant, Newborn
Male
Polymerase Chain Reaction
Pregnancy
Prospective Studies
Retrospective Studies
Risk Assessment
Streptococcal Infections - diagnosis
Streptococcal Infections - etiology
Streptococcal Infections - microbiology
Streptococcus agalactiae - genetics
Streptococcus agalactiae - isolation & purification
Time Factors
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Summary:According to the U.S. Centers for Disease Control guidelines, prolonged rupture of membranes mandates intrapartum antimicrobial prophylaxis for group B Streptococcus whenever maternal GBS status is unknown. To evaluate the local incidence, early detection and outcome of early-onset GBS sepsis in neonates born at 35-42 weeks gestation after PROM to women with unknown GBS status who were not given intrapartum antimicrobial prophylaxis. During a 1 year period we studied all neonates born beyond 35 weeks gestation with maternal PROM > or =18 hours, unknown maternal GBS status and without prior administration of IAP. Complete blood count, C-reactive protein, blood culture and polymerase chain reaction amplification of bacterial 16S rRNA gene were performed in blood samples collected immediately after birth. Unfavorable outcome was defined by one or more of the following: GBS bacteremia, clinical signs of sepsis, or positive PCR. Of the 3616 liveborns 212 (5.9%) met the inclusion criteria. Only 12 (5.7%) of these neonates presented signs suggestive of sepsis. PCR was negative in all cases. Fifty-eight neonates (27.4%) had CRP > 1.0 mg/dl and/or complete blood count abnormalities, but these were not significantly associated with unfavorable outcome. Early-onset GBS sepsis occurred in one neonate in this high risk group (1/212 = 0.47%, 95% CI 0.012-2.6). In this single-institution study, the incidence of early-onset GBS sepsis in neonates born after PROM of 18 hours, unknown maternal GBS status and no intrapartum antimicrobial prophylaxis was 0.47%.
ISSN:1565-1088