PLoS ONE (Jan 2019)

Group B Streptococcus early-onset disease and observation of well-appearing newborns.

  • Alberto Berardi,
  • Caterina Spada,
  • Maria Letizia Bacchi Reggiani,
  • Roberta Creti,
  • Lorenza Baroni,
  • Maria Grazia Capretti,
  • Matilde Ciccia,
  • Valentina Fiorini,
  • Lucia Gambini,
  • Giancarlo Gargano,
  • Irene Papa,
  • Giancarlo Piccinini,
  • Vittoria Rizzo,
  • Fabrizio Sandri,
  • Laura Lucaccioni,
  • GBS Prevention Working Group of Emilia-Romagna

DOI
https://doi.org/10.1371/journal.pone.0212784
Journal volume & issue
Vol. 14, no. 3
p. e0212784

Abstract

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BackgroundInternational guidelines lack a substantial consensus regarding management of asymptomatic full-term and late preterm neonates at risk for early-onset disease (EOS). Large cohorts of newborns are suitable to increase the understanding of the safety and efficacy of a given strategy.MethodsThis is a prospective, area-based, cohort study involving regional birth facilities of Emilia-Romagna (Italy). We compared cases of EOS (at or above 35 weeks' gestation) registered in 2003-2009 (baseline period: 266,646 LBs) and in 2010-2016, after introduction of a new strategy (serial physical examinations, SPEs) for managing asymptomatic neonates at risk for EOS (intervention period: 265,508 LBs).ResultsThere were 108 cases of EOS (baseline period, n = 60; intervention period, n = 48). Twenty-two (20.4%) remained asymptomatic through the first 72 hours of life, whereas 86 (79.6%) developed symptoms, in most cases (52/86, 60.5%) at birth or within 6 hours. The median age at presentation was significantly earlier in the intrapartum antibiotic prophylaxis (IAP)-exposed than in the IAP-unexposed neonates (0 hours, IQR 0.0000-0.0000 vs 6 hours, IQR 0.0000-15.0000, pConclusionsInfants with EOS exposed to IAP developed symptoms at birth in almost all cases, and those who appeared well at birth had a very low chance of having EOS. The risk of EOS in neonates (asymptomatic at birth) exposed to intrapartum fever was low. Although definite conclusions on causation are lacking, our data support SPEs of asymptomatic newborns at risk for EOS. SPEs seems a safe and effective alternative to laboratory screening and empirical antibiotic therapy.