PREVENTION OF NEONATAL GROUP-B STREPTOCOCCAL SEPSIS - IS ROUTINE ANTENATAL SCREENING APPROPRIATE

Four strategies for prevention of early onset neonatal group B strepto coccal (GBS) sepsis were considered: A: routine antenatal screening fo r GBS vaginal carriage at 26-28 weeks' gestation and intrapartum antib iotic prophylaxis for all carriers; B: screening as above and prophyla xis only for carriers with risk factors for sepsis; C: prophylaxis for all women with risk factors; D: as for C plus screening at 37 weeks' gestation and prophylaxis for carriers. The outcomes considered for ea ch option were: the proportion of women given prophylaxis; the risk of anaphylaxis; cases of neonatal GBS sepsis and deaths prevented; costs of screening, prophylaxis and of acute care of remaining cases. Publi shed local and overseas studies of neonatal GBS sepsis, effectiveness of antenatal screening and prophylaxis and estimated costs were evalua ted. Any of the proposed strategies can prevent a significant proporti on of cases of neonatal GBS sepsis and a strategy for prevention of ne onatal group B streptococcal sepsis should be part of routine obstetri c practice. Strategy C is simple, effective, inexpensive and avoids un necessary antibiotic use; it is recommended particularly when antenata l care is provided mainly in community or private practice. Strategy A (using vaginal and rectal swabs for screening) could prevent more cas es, but at greater cost which could be justified only if protocols can be properly implemented and monitored.