%0 Journal Article
%T Duration of Intrapartum Antibiotics for Group B Streptococcus on the Diagnosis of Clinical Neonatal Sepsis
%A Mark A. Turrentine
%A Anthony J. Greisinger
%A Kimberly S. Brown
%A Oscar A. Wehmanen
%A Melanie E. Mouzoon
%J Infectious Diseases in Obstetrics and Gynecology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/525878
%X Background. Infants born to mothers who are colonized with group B streptococcus (GBS) but received <4 hours of intrapartum antibiotic prophylaxis (IAP) are at-risk for presenting later with sepsis. We assessed if <4 hours of maternal IAP for GBS are associated with an increased incidence of clinical neonatal sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ¡Ý37-week gestation who presented in labor from January 1, 2003 through December 31, 2007 was performed. Infants diagnosed with clinical sepsis by the duration of maternal IAP received (< or ¡Ý4-hours duration) were determined. Results. More infants whose mothers received <4 hours of IAP were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus 15 of 3,633 (0.4%), . Multivariate logistic regression analysis showed that treatment with ¡Ý4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16¨C0.79, and . Conclusion. The rate of neonatal clinical sepsis is increased in newborns of GBS colonized mothers who receive <4 hours compared to ¡Ý4 hours of IAP. 1. Introduction Guidelines for group B streptococcus (GBS) originally established in 1996 (and reaffirmed in 2002 and 2010) by the Centers for Disease Control and Prevention (CDC) identify asymptomatic infants born to mothers who were colonized with GBS but received <4 hours of intrapartum antibiotics, as at-risk for presenting later with sepsis [1¨C3]. Past management recommendations for infants have been limited either to evaluation with a blood culture and complete blood count or more recently only just to observation for ¡Ý48 hours [1¨C3]. The origin of this four-hour duration for intrapartum GBS antibiotic prophylaxis is unclear. In the presence of at least one risk factor such as premature delivery <37-week gestation, rupture of membranes >6 hours, or maternal fever of ¡Ý37.5¡ãC, intrapartum antibiotic prophylaxis of <4 hours results in higher rates of vertical transmission of neonatal GBS colonization [4, 5]. Yet even in the presence of maternal risk factors, if intrapartum antibiotic was given at least 2 hours before delivery, the effectiveness in preventing early onset group B streptococci disease was demonstrated [6]. However, the majority of infants exposed to GBS at birth are delivered to colonized mothers without additional risk factors. Small prospective observation studies in women without risk factors have shown a lower rate of infant colonization with GBS, if maternal intrapartum prophylaxis was >4-hour duration
%U http://www.hindawi.com/journals/idog/2013/525878/