Correspondence

Reducing Neonatal Group B Streptococcal Disease

N Engl J Med 2000; 342:1367-1368May 4, 2000

Article

To the Editor:

Schrag et al. (Jan. 6 issue)1 reported a striking 65 percent reduction in the rate of early-onset neonatal group B streptococcal infections in a population-based surveillance program conducted from 1993 to 1998 (a decrease from 1.7 per 1000 live births to 0.6 per 1000). This decline coincided with the issuance of national recommendations to prevent group B streptococcal disease through wider use of prophylactic antibiotics during the intrapartum period. We have seen a similar dramatic reduction in the incidence of early-onset neonatal group B streptococcal disease in our population recently that is directly related to the implementation of a regimen of prophylaxis.

On January 1, 1995, we introduced a treatment protocol for the prevention of group B streptococcal infection among women during the intrapartum period and among neonates. Prophylactic antimicrobial agents for the prevention of group B streptococcal infection were not used between 1988, when we began tracking group B streptococcal infections in this study, and January 1, 1995. Thereafter, all women with preterm labor (<37 weeks' gestation) or a prolonged interval between rupture of the membranes and delivery (≥18 hours) at term received intrapartum ampicillin until delivery. In addition, all full-term infants received 50,000 units of aqueous penicillin G in the delivery room; preterm infants received 25,000 units within one hour of birth. The current cost of the premixed penicillin G, including the syringe, is approximately $0.14 per dose. During the 11 years of the study, maternal chorioamnionitis was treated with ampicillin and gentamicin. Sepsis in infants was confirmed by positive blood cultures within the first three days of life.

There were 102,913 live births before the introduction of this combined prophylaxis regimen, and 54,207 after. The rate of early-onset group B streptococcal sepsis was 2.04 per 1000 live births between 1988 and 1994 and 0.55 per 1000 between 1995 and 1998 (odds ratio, 0.27; 95 percent confidence interval, 0.18 to 0.48; P<0.001) (Figure 1Figure 1Incidence of Early-Onset Group B Streptococcal Infection at the Study Hospital, 1988 through 1998.). There was no significant change in the rate of late-onset group B streptococcal disease or neonatal infections from other bacteria after the introduction of prophylactic treatment.

Institution of the combined-prophylaxis regimen resulted in a dramatic, sustained reduction in early-onset neonatal group B streptococcal infection. On the basis of the differences in rates, we estimate that our prophylaxis regimen prevents 25 cases of neonatal group B streptococcal sepsis annually at our hospital.

A practical and inexpensive regimen of intrapartum prophylaxis given to women at high risk for group B streptococcal infection, in addition to neonatal prophylaxis with penicillin G for all infants, can dramatically and safely reduce the incidence of neonatal group B streptococcal infections. Thus, like Schrag and colleagues, we believe that the reduction in neonatal sepsis is not just coincident with, but directly related to, implementation of peripartum prevention programs.

George D. Wendel, Jr., M.D.
Donald J. McIntire, Ph.D.
Kenneth J. Leveno, M.D.
University of Texas Southwestern Medical School, Dallas, TX 75235-9032

1 References

1. 1

   Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000;342:15-20
   Full Text | Web of Science | Medline