Perinatal risk factors for early onset neonatal infection

Introduction

Neonatal infection and perinatal mortality rate are a big challenge to neonatologists and obstetricians as well. Group B streptococcal (GBS) infection is the most common early onset (EO) neonatal infection with an incidence of 1–4 per 1000 live born in the developed world.

Methods

We studied the newborn infection rate before and after American Academy of Pediatrics (AAP) Protocol implementation in Croatia. The protocol for beta haemolytic streptococcal B infection includes: intrapartum antibiotic prophilaxis with ampicillin and gentamycin in preterm labour at < 37 weeks of gestation, premature rupture of membranes at < 37 weeks of gestation, fever during labour, ruptures of membranes >18 hours before delivery and previous delivery of a sibling with invasive GBS disease.

Results

Of 784 neonates admited to the NICU, between 1 January 2003. and 31 December 2003, 60 (14 per 1000 live born) developed definite, culture confirmed, early onset (< 48 hours) GBS infection and seven (two per 1000 live born) developed probable infection (clinical signs consistent with EOGBS in a baby under 48 hours old, colonised with group B streptococci).

Discussion

Conatal infection increases the sensitivity of the foetal brain to hypoxia and has later neuro risk sequelae to the newborn child. Our data suggest that the incidence of GBS infection in our country was considerably higher than in all current studies. Reasons for that can be inadequate perinatal screen in some parts of the country and no established policy for intrapartum antibiotic treatment of women with antenatal risk factors. In our study more than 80% of women who delivered neonates with EOGBS disease had at least one of the risk factors. After the year 2000, when we started the AAP Protocol, the incidence of infection decreased to 5/1000 live born infants. The mortality from EOGBS dropped to 3%.

Conclusion

It is very important to establish a basis for trials of different strategies to reduce EOGBS infections in countries in transition with low social and economy status. Our results documented that the AAP Protocol for beta haemolytic streptococcal B infection can significantly reduce perinatal mortality of neonatal infection and sepsis.