Comparison of two prevention strategies for neonatal group B streptococcal disease

BACKGROUND: Neonatal group B streptococcal disease is a serious infection, causing more than 2,000 cases of sepsis annually. The Centers for Disease Control and Prevention has recommended two alternative strategies to prevent infection, but few data directly compare the two in terms of intrapartum antibiotic administration, protocol feasibility, newborn laboratory evaluation, and costs. METHODS: We collected data on intrapartum antibiotic administration, protocol compliance, newborn laboratory evaluation, and maternal-newborn length of stay for 347 mother-infant pairs in a family practice residency maternity service. During the first study period, laboring women were managed under the screening strategy, and during the second study period, laboring women were managed under the risk factor strategy. RESULTS: Of those women who qualified for antibiotic prophylaxis, only 28% of women in the screening group and 47% of women in the risk factor group actually received the recommended two or more doses of intrapartum antibiotics. Ninety-one percent of women in the screening group had prenatal cultures done appropriately. Newborns in the screening group had an increased risk of having a complete blood count (OR = 1.35, 95% CI 1.01, 1.80). There was no difference between groups in maternal or newborn length of stay. CONCLUSIONS: A minority of laboring women in either strategy received the recommended doses of intrapartum antibiotics. Feasibility of obtaining prenatal screening cultures is high. Although newborn laboratory testing increased with the screening strategy, overall costs and length of stay were comparable.