Document Detail

Neonatal group B streptococcal infection in a managed care population. Perinatal Group B Streptococcal Infection Study Group.
MedLine Citation:
PMID:  9649086     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: In a health maintenance organization population, we determined the incidence of early-onset (at less than or equal to 7 days) neonatal group B streptococcal (GBS) disease, the sensitivity and prevalence of labor risk factors, the adherence to a protocol for intrapartum antibiotics, and the costs for care of and outcomes of affected infants. METHODS: Mothers and infants at four health maintenance organization hospitals in northern California in 1989 to 1995 were studied retrospectively using computerized databases and chart review. In 1994, two of the four hospitals had adopted protocols similar to the ACOG recommendations for intrapartum antibiotics for women with labor risk factors (preterm, temperature 100.4F or higher, or rupture of membranes (ROM) 18 hours or more). RESULTS: Among the 79,940 live births, the incidence of early-onset neonatal GBS infection was higher among preterm than among term infants (3.1 compared with 0.9 per 1000). Before protocol adoption, 68% of 65 infants with GBS had mothers with labor risk factors. Approximately 18% of all mothers had labor risk factors: 7.7% had preterm delivery, and 10.6% had term delivery with fever and/or ROM 18 hours or more. At the two hospitals that adopted GBS protocols, GBS incidence was reduced from 1.3 per 1000 in the preprotocol period to 0.8 per 1000 in the postprotocol period (P=.08). Six cases of neonatal GBS occurred after protocol adoption. Of these, four were not preventable under the protocol and two might have been preventable if protocol had been followed. Three of the 19 preterm infants with group B streptococcal disease died. CONCLUSION: Risk factor-based protocols hold some promise to reduce GBS disease, but clinical strategies to promote protocol adherence are needed.
T A Lieu; J C Mohle-Boetani; G T Ray; L M Ackerson; D L Walton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  92     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-07-23     Completed Date:  1998-07-23     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  21-7     Citation Subset:  AIM; IM    
Division of Research, The Permanente Medical Group, Oakland, California 94611, USA.
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MeSH Terms
Antibiotic Prophylaxis
Costs and Cost Analysis
Guideline Adherence
Health Maintenance Organizations
Infant, Newborn
Obstetric Labor Complications / epidemiology,  prevention & control
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Streptococcal Infections / economics,  epidemiology*
Streptococcus agalactiae*
United States

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