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Infectious Diseases in Obstetrics and Gynecology
Volume 8, Issue 3-4, Pages 143-150
http://dx.doi.org/10.1155/S1064744900000181

Liberal Diagnosis and Treatment of Intrauterine Infection Reduces Early-Onset Neonatal Group B Streptococcal Infection but not Sepsis by Other Pathogens

1Department of Obstetrics and Gynecology, Room H4-205, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands
2Department of Neonatology, Academic Medical Center, Amsterdam, The Netherlands
3Department of Microbiology, Academic Medical Center, Amsterdam, The Netherlands

Received 7 February 2000; Accepted 11 April 2000

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective: Comparison of the incidence and case fatality of early-onset group B streptococcus sepsis and sepsis caused by other pathogens in neonates after change of management of intrauterine infection.

Methods: All infants delivered from 1988 through 1997 at a gestational age ≥ 24 weeks with a birth weight ≥ 500 gram without lethal congenital abnormalities were eligible for inclusion. Infants delivered by cesarean section before the onset of labor or rupture of membranes were excluded. During the first period (1988–1991) intrauterine infection was diagnosed by a temperature > 38℃, during the second period (1992–1997) this diagnosis was made at a lower temperature (≥ 37.8℃) or by fetal tachycardia ≥ 160/min. Treatment of intrauterine infection was similar during both periods with 3 × 2 gram amoxicillin and 1 × 240 mg gentamicin every 24 hours intravenously during labor. Prophylactic treatment during labor was only given to women with a history of an earlier infant with early-onset group B streptococcus sepsis.

Results: During the first period 6,103 infants were included, during the second period 8,504. Intrauterine infection was diagnosed and treated more often in the second period (7.1% vs. 2.6%). The incidence of early-onset group B streptococcus sepsis was significantly lower in the second period than in the first period [0.2% vs. 0.4%; OR 0.5 (0.3–0.9)] and survival without disability higher [80% vs. 52%; OR 4.5 (1.4–16.5)]. However, in both periods the overall incidence of neonatal sepsis (3.6% vs. 3.5%) and overall mortality because of sepsis (14.3% vs.13.1%) were similar.

Conclusions: Although the early detection of clinical signs of intrauterine infection might have been effective for the prevention of serious sequelae of early-onset group B streptococcus sepsis the overall incidence and mortality from neonatal sepsis remained unchanged. Evaluation of preventive measures for early-onset group B streptococcus sepsis should always take the incidence of neonatal sepsis caused by other pathogens into account. Infect. Dis. Obstet. Gynecol. 8:143–150, 2000.