Epidemiology and predictive values of risk factors for neonatal group B streptococcal sepsis
| Autor: | Gwendolyn L. Gilbert, MC Hewitt, CM Turner, Stephen R. Leeder |
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| Rok vydání: | 2002 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Population Group B Streptococcus agalactiae Cohort Studies Neonatal Screening Predictive Value of Tests Pregnancy Risk Factors Prenatal Diagnosis Sepsis Streptococcal Infections Epidemiology Humans Medicine Pregnancy Complications Infectious Antibiotic prophylaxis education reproductive and urinary physiology Retrospective Studies education.field_of_study Neonatal sepsis business.industry Obstetrics Incidence Incidence (epidemiology) Infant Newborn Obstetrics and Gynecology General Medicine Antibiotic Prophylaxis medicine.disease Carriage Carrier State Female business Cohort study |
| Zdroj: | The Australian and New Zealand Journal of Obstetrics and Gynaecology. 42:497-503 |
| ISSN: | 1479-828X 0004-8666 |
| Popis: | Objectives To determine the incidence of and factors affecting risk factors for neonatal group B streptococcal (GBS) sepsis and their predictive values for intrapartum GBS carriage; to calculate the proportions of women eligible for intrapartum antibiotic prophylaxis (IAP) using different selection protocols. Design Cohort study. Setting Antenatal clinics and labour wards of a community hospital and a tertiary referral centre in western Sydney. Population Women attending antenatal clinics during the study periods were invited to participate. Methods Approximately 500 women attending antenatal clinics were screened for GBS carriage at 26–32 weeks gestation and at delivery, using several screening methods. Clinical risk factors for neonatal sepsis were recorded during labour. Main outcome measures Incidence of antenatal anovaginal GBS carriage and clinical risk factors during labour, their predictive values for intra-partum GBS carriage and their relationship, if any, to demographic and obstetric factors. Results Antenatal and intra-partum GBS carriage rates were similar but varied from 18% to 27%, depending on screening methods. The best positive and negative predictive values of antenatal GBS culture, for intra-partum carriage, were 69% (95% confidence interval (CI) 64–74) and 92% (95% CI 50–94) respectively. Clinical risk factors occurred in similar proportions of GBS carriers and non-carriers. Conclusions Neither early antenatal screening nor clinical risk factors are reliable predictors of intra-partum GBS carriage. Intra-partum antibiotic prophylaxis based on GBS carriage or risk factors when carrier status is unknown would involve ∼35% of women, compared with ∼16% if based on risk factors only. Both strategies would prevent similar proportions of neonatal deaths from GBS sepsis. Compliance with a preventive protocol is the most likely determinant of its overall effectiveness. |
| Databáze: | OpenAIRE |
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