Strategies for preventing early-onset sepsis and for managing neonates at-risk: wide variability across six Western countries

Abstract

Objective: Group B streptococcus (GBS) early-onset sepsis (EOS) has declined after widespread intrapartum antibiotic prophylaxis. However, strategies for preventing EOS may differ across countries. The analysis of their strategies allows to compare the effectiveness of prevention in different countries and suggests opportunities for improvement.

Methods: We compared six western countries. Prevention strategies, incidence rates of EOS and approaches for managing neonates at-risk were analysed. Countries were selected because of availability of recommendations for prevention and sufficient epidemiological data for comparison.

Results: Five of six countries recommend antenatal vagino-rectal screening. The decline of GBS cases is relevant in most countries, particularly in those with a screening-based strategy, which have reached incidence rates from 0.1 to 0.3/1000 live births and zero or close to zero mortality in full-term newborns. The recommendation for managing asymptomatic neonates at risk for EOS varies according to gestational age and ranges from observation only to laboratory testing plus empirical antibiotics. Chorioamnionitis (suspected or confirmed) is the main indication for carry out laboratory testing and for administering empirical antibiotics.

Conclusions: Wide variations exists in preventing EOS. They depend on national epidemiology of GBS infections, compliance, cost, and feasibility of the strategy. The extreme variability of approaches for managing neonates at risk for EOS reflects the even greater uncertainty regarding this issue, and may explain the persisting, great use of resources to prevent a disease that has become very rare nowadays.

Keywords:

• Group B streptococcus
• neonatal sepsis
• intrapartum antibiotic prophylaxis
• newborn infant
• risk factors
• prevention

Acknowledgements

We thank the GBS Prevention Working Group of Emilia-Romagna (components are listed as follows): L. Memo, G. Nicolini (Ospedale San Martino, Belluno); M. Ciccia, A. Bastelli, F. Sandri (Ospedale Maggiore, Bologna); S. Ambretti, M.G. Capretti, L. Corvaglia, A. Dondi, M. Lanari, L. Pasini, L. Ragni, (Policlinico Sant’Orsola, Bologna); A. Albarelli (Ospedale Santa Maria, Borgo Taro); V. Fiorini, C. Giugno, P. Lanzoni (Ospedale B. Ramazzini, Carpi); E. Di Grande, A. Polese (Ospedale Sant’Anna, Castelnuovo Monti); M.C. China, V. Rizzo, M Stella (Ospedale M. Bufalini, Cesena); A. Zucchini (Ospedale Civile, Faenza); L. Malaguti (Ospedale del Delta, Ferrara); M. Azzalli, G. Garani, C. Lama (Ospedale Sant’Anna, Ferrara); S. Nasi, P. Bacchini, G. Fragni (Ospedale di Vaio, Fidenza); P. Baldassarri, R.M. Pulvirenti, E. Valletta, V. Venturoli (Ospedale Morgagni-Pieratoni, Forlì); C. Alessandrini, M.L. Bidetti, S. Storchi Incerti (Ospedale Civile, Guastalla); C. Di Carlo, A. Lanzoni, L. Serra, D. Silvestrini (Ospedale Santa Maria della Scaletta, Imola); A. Berardi F. Facchinetti, F. Ferrari, L. Lugli, C. Venturelli (Azienda Ospedaliera Policlinico, Modena); M. Sarti (Ospedale Baggiovara, Modena); A. Volta (Ospedale Franchini, Montecchio Emilia); I. Dodi, L. Gambini, C. Magnani (Ospedale Policlinico, Parma); B. Guidi (Ospedale Civile, Pavullo); M. Bertelli, G. Biasucci, R. Chiarabini, N. De Paulis, D. Padrini, S. Riboni (Ospedale G. da Saliceto, Piacenza); M.F. Pedna, V. Sambri (Laboratorio Area Vasta Emilia-Romagna, Pievesestina); L. Casadio, F. Marchetti, C. Muratori, G. Piccinini, C. Renzelli (Ospedale Santa Maria delle Croci, Ravenna); S. Amarri, L. Baroni, E. Carretto, S. Fornaciari, G. Gargano, S. Pedori, M. Riva, C. Zuelli (Ospedale Santa Maria Nuova, Reggio Emilia); G. Ancona, S. Bolognesi, I. Papa, G. Vergine, L. Viola (Ospedale Infermi, Rimini); C. Chiossi, R. Pagano, C. Rivi, C. Zanacca (Ospedale Civile, Sassuolo); C. Bonvicini, R. Palmieri (Ospedale C. Magati, Scandiano).

Disclosure statement

No potential conflict of interest was reported by the authors relevant to this article to disclose.

Additional information

Funding

Alberto Berardi has received funding from these Companies: Pfizer (2015), Putnam Associates (2016), and GSK (2017). The other authors declare that they have no funding source.