Original Article

Journal of Perinatology (2013) 33, 198–205; doi:10.1038/jp.2012.96; published online 19 July 2012

Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines

S Mukhopadhyay1,5, E C Eichenwald2 and K M Puopolo1,3,4,5

  1. 1Division of Newborn Medicine, Children's Hospital Boston, Boston, MA, USA
  2. 2Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center, Houston, TX, USA
  3. 3Channing Laboratory 181 Longwood Avenue, Boston, MA, USA
  4. 4Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
  5. 5Harvard Medical School, Boston, MA, USA

Correspondence: Dr KM Puopolo, Department of Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: kpuopolo@partners.org

Received 1 February 2012; Revised 11 June 2012; Accepted 12 June 2012
Advance online publication 19 July 2012

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Abstract

Objective:

 

To determine (a) the proportion of asymptomatic infants born at greater than or equal to35 weeks gestation evaluated for early-onset sepsis (EOS) and exposed to postnatal antibiotics; (b) reasons for and outcomes of the evaluations, and (c) anticipated changes when applying the Centers for Disease Control and Prevention (CDC) 2010 guidelines to this study population.

Study Design:

 

Retrospective cohort study of infants born at greater than or equal to35 weeks gestation in 2008–2009 in a large maternity center.

Result:

 

Out of the 7226 infants that met the study criteria: 1062 (14.7%) were evaluated for EOS and half of those evaluated, received empiric antibiotics. 70.4% of evaluations were performed owing to maternal intrapartum fever, but 23% were prompted by inadequate Group B Streptococcus (GBS) prophylaxis alone. Three cases of blood culture-proven infection were identified.

Conclusion:

 

Improved approaches are needed to identify asymptomatic infants who are at risk for EOS to decrease unnecessary evaluations and antibiotic exposure. Transition to the 2010 CDC GBS guidelines may eliminate a quarter of EOS evaluations among these infants.

Keywords:

group B Streptococcus; intrapartum antibiotic prophylaxis; neonatal screening; neonatal infection; asymptomatic infection; early-onset sepsis