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Impact of Perinatal Practices for Early-onset Group B Streptococcal Disease Prevention

Berardi, Alberto MD*; Lugli, Licia MD*; Rossi, Cecilia MD*; Guidotti, Isotta MD*; Lanari, Marcello MD; Creti, Roberta PhD; Perrone, Enrica MD§; Biasini, Augusto MD; Sandri, Fabrizio MD; Volta, Alessandro MD**; China, Mariachiara MD††; Sabatini, Laura MD‡‡; Baldassarri, Lucilla PhD; Vagnarelli, Federica MD§§; Ferrari, Fabrizio MD*; on behalf of the GBS Prevention Working Group, Emilia-Romagna

Pediatric Infectious Disease Journal: July 2013 - Volume 32 - Issue 7 - p e265–e271
doi: 10.1097/INF.0b013e31828b0884
Original Studies

Background: Prevention of residual cases of neonatal group B streptococcus (GBS) early-onset disease (EOGBS) has become a goal in the past decade. This study is aimed at evaluating changes in the incidence of EOGBS over a 9-year period after the implementation of a screening-based approach and comparing 2 different protocols for managing healthy-appearing at-risk newborns (ARNs).

Methods: A screening-based strategy was introduced in Emilia-Romagna (Italy) in 2003. A prospective, cohort study was conducted from 2003 to 2011; culture-proven EOGBS cases were analyzed in 2 periods: period 1 (2003 to 2008) and period 2 (2009 to 2011). ARNs (≥35 weeks’ gestation) were managed according to 2 different protocols: laboratory testing plus observation (period 1) was replaced with expectant observation alone (period 2).

Results: Ninety-one EOGBS cases were observed (incidence rate: 0.26/1000 live births). The incidence in full-term babies declined from 0.30 (period 1) to 0.14/1000 live births (period 2, P = 0.04). Recto-vaginal screening cultures in full-term mothers increased significantly from 10/45 (period 1) to 10/14 (period 2, P = 0.002). EOGBS was diagnosed earlier in ARNs than in not-at-risk newborns (mean age 5.5 versus 14.5 hours, P = 0.007). There were no differences in age at diagnosis irrespective of whether ARNs were managed with laboratory testing plus observation (mean 3.5 hours, period 1) or with expectant observation alone (mean 2.4 hours, period 2).

Conclusions: When screening cultures were handled according to standard protocols, cases of EOGBS in full-term newborns simultaneously decreased. ARNs were diagnosed in a timely manner through both strategies. The clinical yield of laboratory testing was negligible.

From the *Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena; Unità Operativa di Pediatria e Neonatologia, Ospedale Santa Maria della Scaletta, Imola; Unità per le Malattie Batteriche Sistemiche e Respiratorie, Dipartimento MIPI, Istituto Superiore di Sanità, Roma; §Centro per la Valutazione dell’Efficacia dell’Assistenza Sanitaria CeVEAS, Azienda USL, Modena; Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini, Cesena; Unità Operativa di Terapia Intensiva Neonatale, Ospedale Maggiore, Bologna; **Nido, Ospedale Franchini, Montecchio; ††Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi, Rimini; ‡‡Unità Operativa di Terapia Intensiva Neonatale, Ospedale Santa Maria delle Croci, Ravenna; and §§Unità Operativa di Terapia Intensiva Neonatale, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.

The research leading to these results has received funding from the European Community’s Seventh Framework Programme [FP7/2007–2013] under grant agreement n° HEALTH-F7-2007–200481 DEVANI. This study has also been supported by an Italian Ministry of Health Grant “Valutazione delle infezioni neonatali precoci e tardive da streptococco di gruppo B (GBS) nel nostro paese e dei sierotipi circolanti causa di malattia” (Grant 7M32). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Alberto Berardi, MD, Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliero- Universitaria Policlinico, Via del Pozzo 71 - 41124 Modena, Italy. E-mail: berardi.alberto@policlinico.mo.it.

© 2013 by Lippincott Williams & Wilkins, Inc.