Early Human Development 90S1 (2014) S35–S38
Which is the optimal algorithm for the prevention of neonatal early-onset group B streptococcus sepsis? Chryssoula Tzialla *, Alessandro Borghesi, Stefania Longo, Mauro Stronati Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
A R T I C L E
I N F O
Keywords: Group B streptococcal disease Neonate Prevention
A B S T R A C T The incidence of neonatal early-onset group B streptococcus (GBS EOS) sepsis has declined during the last decade since the implementation of intrapartum antibiotic prophylaxis endorsed by Centers for Disease Control and Prevention (CDC) guidelines. All the CDC guidelines versions provide recommendations for neonatal management. The neonatal algorithm of CDC has not been universally accepted and hence different algorithms have been suggested. Since all approaches to disease prevention are still imperfect, an optimal algorithm for GBS EOS prevention is still lacking; the development of improved diagnostic methods of distinguishing at-risk infants may contribute to improve the clinician’s approach. © 2014 Elsevier Ireland Ltd. All rights reserved.
Since 1970, Group B Streptococcus (GBS) has been the predominant bacterial cause of early neonatal sepsis and meningitis. Over the past 10 years, due to the widespread adoption of intrapartum antibiotic prophylaxis (IAP), a significant reduction in the incidence of the early-onset group B streptococcal disease has been achieved [1]. Nevertheless GBS remains a leading infectious cause of neonatal morbidity and mortality in industrialized countries causing over one-third of invasive early-onset sepsis (EOS) cases in the US [1,2]. The incidence of GBS EOS, since the recommendations of the 1996 guidelines and their 2002 modification published by CDC [3] on the IAP use, has declined from 1.7 cases/1000 live births to 0.34–0.37 cases/1000 live births [4] in the US. The case fatality ratio has fallen, over the past 25 years, from 25–50% to 4–6% [4,5]. Furthermore the meningeal invasion accompanying EOS has been reduced from 25% of cases in the 1980s to 4% [5]. IAP is, currently, the only intervention proven to decrease the incidence of GBS EOS. A Cochrane systematic review identify three trials involving 852 GBS colonized women were was evaluate the effects of IAP versus no treatment. The use of IAP reduces the incidence of GBS EOS by 83% compared with no treatment (risk ratio 0.17, 95% CI 0.04–0.74) [6]. IAP reduces, but does not eliminate early onset neonatal GBS disease. Clinicians must therefore detect potential sepsis cases in newborns as early as possible and neonates should be managed according suggested algorithms. Indeed all the CDC guidelines versions for the prevention of neonatal GBS disease provide recommendations for the evaluation of newborns for EOS [3,4].
* Corresponding author: Chryssoula Tzialla, SC Neonatologia, Patologia Neonatale e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico “San Matteo”, Piazzale Golgi 11, 27100 Pavia (PV), Italy. Tel.: +39 0382 502704; fax: +39 0382 502477. E-mail address: [email protected] (C. Tzialla). 0378-3782/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved.
Early in November of 2010, the CDC published an update of the 2002 guidelines [4]. The new neonatal recommendations are summarized in Fig. 1. A significant change in the CDC 2010 revision pertinent to newborn EOS assessment was the recommendation to evaluate infants for inadequate IAP only if additional risk factors were present, including maternal intrapartum fever, birth at
Which is the optimal algorithm for the prevention of neonatal early-onset group B streptococcus sepsis? Chryssoula Tzialla *, Alessandro Borghesi, Stefania Longo, Mauro Stronati Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
A R T I C L E
I N F O
Keywords: Group B streptococcal disease Neonate Prevention
A B S T R A C T The incidence of neonatal early-onset group B streptococcus (GBS EOS) sepsis has declined during the last decade since the implementation of intrapartum antibiotic prophylaxis endorsed by Centers for Disease Control and Prevention (CDC) guidelines. All the CDC guidelines versions provide recommendations for neonatal management. The neonatal algorithm of CDC has not been universally accepted and hence different algorithms have been suggested. Since all approaches to disease prevention are still imperfect, an optimal algorithm for GBS EOS prevention is still lacking; the development of improved diagnostic methods of distinguishing at-risk infants may contribute to improve the clinician’s approach. © 2014 Elsevier Ireland Ltd. All rights reserved.
Since 1970, Group B Streptococcus (GBS) has been the predominant bacterial cause of early neonatal sepsis and meningitis. Over the past 10 years, due to the widespread adoption of intrapartum antibiotic prophylaxis (IAP), a significant reduction in the incidence of the early-onset group B streptococcal disease has been achieved [1]. Nevertheless GBS remains a leading infectious cause of neonatal morbidity and mortality in industrialized countries causing over one-third of invasive early-onset sepsis (EOS) cases in the US [1,2]. The incidence of GBS EOS, since the recommendations of the 1996 guidelines and their 2002 modification published by CDC [3] on the IAP use, has declined from 1.7 cases/1000 live births to 0.34–0.37 cases/1000 live births [4] in the US. The case fatality ratio has fallen, over the past 25 years, from 25–50% to 4–6% [4,5]. Furthermore the meningeal invasion accompanying EOS has been reduced from 25% of cases in the 1980s to 4% [5]. IAP is, currently, the only intervention proven to decrease the incidence of GBS EOS. A Cochrane systematic review identify three trials involving 852 GBS colonized women were was evaluate the effects of IAP versus no treatment. The use of IAP reduces the incidence of GBS EOS by 83% compared with no treatment (risk ratio 0.17, 95% CI 0.04–0.74) [6]. IAP reduces, but does not eliminate early onset neonatal GBS disease. Clinicians must therefore detect potential sepsis cases in newborns as early as possible and neonates should be managed according suggested algorithms. Indeed all the CDC guidelines versions for the prevention of neonatal GBS disease provide recommendations for the evaluation of newborns for EOS [3,4].
* Corresponding author: Chryssoula Tzialla, SC Neonatologia, Patologia Neonatale e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico “San Matteo”, Piazzale Golgi 11, 27100 Pavia (PV), Italy. Tel.: +39 0382 502704; fax: +39 0382 502477. E-mail address: [email protected] (C. Tzialla). 0378-3782/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved.
Early in November of 2010, the CDC published an update of the 2002 guidelines [4]. The new neonatal recommendations are summarized in Fig. 1. A significant change in the CDC 2010 revision pertinent to newborn EOS assessment was the recommendation to evaluate infants for inadequate IAP only if additional risk factors were present, including maternal intrapartum fever, birth at
