INTRAPARTUM CHEMOPROPHYLAXIS FOR GROUP-B STREPTOCOCCUS INFECTION TO PREVENT NEONATAL DISEASE - WHO SHOULD BE TREATED

The purpose of this study was to examine the maternal risk factors ass ociated with early onset Group B streptococcus (CBS) sepsis and determ ine the potential impact of intrapartum chemoprophylaxis using these r isk factors. Using a computerized perinatal database, 26,525 deliverie s over a five-year period (1989 to 1994) were identified. Neonates wit h GBS-positive cultures were identified and the neonatal and maternal chart of each case was reviewed. Twenty-six neonates (1 of 1000) had C BS sepsis documented by blood or cerebrospinal fluid culture. Maternal risk factor(s) were identified in 13 (50%) cases: preterm labor (5), preterm premature rupture of the membranes (5), prolonged rupture of m embranes (6), sibling affected by symptomatic GBS infection (2), or ma ternal fever during labor (5). There were four mothers whose neonates had GBS sepsis in spite of intrapartum antibiotics. Intrapartum chemop rophylaxis for GBS based on risk factors alone will identify only half of the neonates who develop disease. Extension of intrapartum chemopr ophylaxis to patients without risk factors appears to be necessary to prevent early onset disease in the other half. Since 85.7% of our tota l obstetrical population has no risk factors, this policy would requir e treating 1749 women to prevent one case of GBS sepsis. Chemoprophyla xis could be more appropriately targeted if mothers colonized with GBS could be identified in early labor.