PREVENTION OF NEONATAL GROUP-B STREPTOCOCCAL INFECTION

Neonatal group B streptococcal infection is the primary cause of neona tal morbidity related to infection. It can often be prevented by ident ifying and treating pregnant women who carry group B streptococci or w ho are at highest risk of transmitting the bacteria to newborns. Incre asing evidence and expert opinion support intrapartum treatment of wom en at relatively high risk of delivering an infant with group B strept ococcal infection. Such women can be identified through the use of an anogenital culture for group B streptococci obtained at 35 to 37 weeks of gestation and by the presence of at least one of many risk factors associated with neonatal infection. These risk factors include preter m labor or rupture of the membranes at less than 37 weeks of gestation , previous delivery of an infant with invasive group B streptococcal d isease, group B streptococcal bacteriuria during the present pregnancy , maternal intrapartum fever of 38 degrees C (100.4 degrees F) or high er and rupture of the fetal membranes for 18 hours or more. The recomm ended agent for intrapartum chemoprophylaxis is intravenous penicillin G; clindamycin is used in penicillin-allergic women. The use of risk markers alone to guide the administration of intrapartum antibiotics i s much more cost-effective than other preventive strategies, but it ex poses more women and infants to antibiotic-associated risks. Managemen t of the infants of treated mothers is empiric and is currently guided by expert opinion.