Evaluation of neonatal sepsis screening in a tropical area part II: Evaluation of intrapartum chemoprophylaxis protocol

The authors report on an analysis of a chemoprophylaxis protocol at the Uni versity Hospital of Guadeloupe in the Caribbean. This study comprised 6,060 consecutive deliveries and was initiated to assess the application of an i ntrapartum chemoprophylaxis protocol, evaluate its results, and try to iden tify possible necessary modifications to the existing protocol. Although mo re than 90% of women had at least one bacterial screening (vaginal or urina ry) during the last trimester of pregnancy, approximately 75% of mothers wh o were heavily colonized group B streptococcus (GBS) at delivery were not d etected by this systematic screening. As is also reported in other tropical areas where a great proportion of neonatal sepsis occurs in term babies, l ow birthweight was not a specific risk factor in this study when controllin g for other major risk factors such as fever and premature rupture of membr anes. Intrapartum chemoprophylaxis was associated with an approximate three fold decrease in the risk of GBS neonatal bacteraemia among at risk deliver ies. The results suggest that, in our tropical context, prolonged rupture o f membranes of at least 12 hours' duration should be considered as a cause for intrapartum chemoprophylaxis as it accounted for the majority of eases of neonatal bacteraemia that escaped the existing protocol.