Penicillin in Infants Weighing Two Kilograms or Less with Early-Onset Group B Streptococcal Disease

Pyati, Suma; Pildes, Rosita S.; Jacobs, Norman; Ramamurthy, Rajam S.; Yeh, Tsu F.; Raval, D.; Lilien, Lawrence D.; Amma, P L S; Metzger, William I.

doi:10.1056/nejm198306093082303

Cited by 127 publications

(24 citation statements)

References 23 publications

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“…Term infected neonates had moderately ele-Laerdal/Austgulen vated mediator levels in umbilical plasma. In contrast to preterms, a majority developed symptoms after delivery, as previously reported [22]. Thus, infected term neonates could be exposed to bacteria later than the preterms, possibly during the passage of the birth canal.…”

Section: Discussionmentioning

confidence: 53%

Inflammatory Mediators in Umbilical Plasma from Neonates Who Develop Early-Onset Sepsis

Døllner

Vatten

Linnebo³

et al. 2001

Neonatology

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Objectives: To study whether early-onset neonatal sepsis is associated with a prenatal immune response with elevated umbilical plasma levels of inflammatory mediators, and to study whether mediator levels may be helpful in identifying infected neonates. Setting: Nested case-control study. Methods: Cord blood was sampled from 7,073 consecutively delivered neonates. After review of the medical records, neonates suspected to suffer from infection were classified as infected (n = 52) or noninfected but sick controls (n = 33). We also included a group of healthy controls (n = 99). Umbilical plasma levels of tumour necrosis factor-α (TNFα), interleukin (IL)-1β, IL-6, IL-8, soluble TNF receptors (p55 and p75), IL-1 receptor antagonist (IL-1RA) and C-reactive protein were measured by immunoassays. Results: Infected neonates had higher levels of TNFα, IL-1β, IL-6, IL-8, p55, p75 and IL-1RA than healthy controls (all p < 0.01). Among preterm infants (GA <37 weeks), those with infection (n = 11) had higher levels of IL-1β, IL-6, IL-8, p55 and p75 than noninfected sick controls (n = 13) (all p < 0.05), but among term infants, the infected did not differ from the noninfected sick controls. Receiver operator characteristic plots showed that IL-1β, IL-6 and IL-8 identified preterm infected neonates accurately. Conclusions: Early-onset neonatal sepsis is associated with a prenatal immune response with increased TNFα, IL-1β, IL-6, IL-8, p55, p75 and IL-1RA levels in umbilical plasma. Among neonates who present symptoms suggestive of infection, cytokine levels may be helpful in identifying preterm, but not term infected individuals.

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Section: Discussionmentioning

confidence: 53%

Inflammatory Mediators in Umbilical Plasma from Neonates Who Develop Early-Onset Sepsis

Døllner

Vatten

Linnebo³

et al. 2001

Neonatology

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“…17 Ascertainment error is of particular concern for retrospective studies, of which only three are considered in these analyses. 46,56,93 Errors attributable to ascertainment bias are likely to be few for the studies in which blood cultures were performed uniformly on all enrolled infants 48,57,69,94,98 . In one study, blood cultures were obtained routinely from infants who received postpartum penicillin prophylaxis, but not from infants reported as historical control subjects, 90 creating the potential for overascertainment in the penicillin-treated group.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a one-tailed test, which is more appropriate for evaluating the safety of an intervention, shows that the total mortality attributable to bacterial disease was also significantly greater in penicillin-treated infants (pooled OR: 1.4; lower 95% confidence limit: 1.05). Pyati et al found that postpartum penicillin prophylaxis was ineffective for infants with birth weights Յ2000 g 94 and suggested that fetal infection is established before delivery, because symptoms are present soon after birth in most infants with EOGBS infection. 95 Universal postpartum prophylaxis fails to improve overall outcomes, is associated with a higher mortality rate, and, therefore, should be contraindicated.…”

Section: Postpartum Prophylaxismentioning

confidence: 99%

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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ABSTRACT. Objective. To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.Study Design. Literature review and reanalysis of published data.Results. The rate of early-onset GBS sepsis in highrisk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.Conclusions. Women with chorioamnionitis or preterm premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. Pediatrics 1999;103(6). URL: http://www.pediatrics.org/cgi/content/full/103/6/e78; group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.ABBREVIATIONS. EOGBS, early-onset neonatal group B streptococcus infection; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; GBS, group B streptococcus. P revention of early-onset neonatal group B streptococcal (EOGBS) sepsis requires the identification of infants who are at high risk and the use of effective preventive intervention. The American Academy of Pediatrics (AAP), 1,2 American College of Obstetricians and Gynecologists (ACOG), 3,4 and Centers for Disease Control and Prevention (CDC) 5 agree that this intervention should be intrapartum antibiotic treatment. The commentaries that accompany those recommendations and several recent cost-benefit or efficacy analyses implicitly 1-7 or explicitly 8 -11 assume that intrapartum antimicrobial prophylaxis is 100% effective, but reports of at least 50 cases of EOGBS disease in infants whose mothers received intrapartum prophylaxis [12][13][14][15] demonstrate that this cannot be correct. The decision analysis cited by the CDC recommendations 1...

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“…However, an effective vaccine is not yet available [6]. Antibiotic treatment during pregnancy is not adequate [7], neither can single-dose penicillin prophylaxis in infants be recommended [8]. Intrapartum prevention with antibiotic therapy (ampicillin, penicillin G) has been shown to reduce GBS vertical transmission [9][10][11][12][13][14][15][16].…”

Section: Ah Adriaanse Et a I /European Journal Of Obstetrics And Gymentioning

confidence: 99%

Randomized study of vaginal chlorhexidine disinfection during labor to prevent vertical transmission of group B streptococci

Adriaanse¹,

Kollée²,

Muytjens³

et al. 1995

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To evaluate the effect of vaginal disinfection with chlorhexidine gel during labor on vertical transmission of group B streptococcus, as a method to prevent vertical transmission and subsequent neonatal early onset group B streptococcal disease. Study Design: A prospective study with randomization of 1020 parturients to one of three groups as soon as labor started. In all parturients, anus, introitus and cervix were cultured semiquantitatively. Two groups were treated double-blindly with 10 ml of either a 0.3% chlorhexidine gel or a placebo gel, applicated around the portio and into the fomices. If labor still continued, a second application was given after 10 h. The third group received no treatment. Ear, pharynx and umbilicus of all newborns were also cultured semiquantitatively. Results: Nine hundred and eighty one women were evaluated. The overall incidence of group B strep tococcal carriership was 19.4%. Vertical transmission was 52.4% in the chlorhexidine group, 71.4% in the placebo group and 66.7% in the control group (P = 0.069). When testing the transmission rates for the chlorhexidine versus the combined placebo plus control group (69.3%), the difference was 16.9% (P ~ 0.026). Conclusion: Vaginal disinfection with a chlorhexidine gel during labor modest ly reduces group B streptococcal vertical transmission. Because the method is cheap, simple and safe, it should be considered for routine use. Our results indicate that it may reduce the incidence of early onset group B streptococcal sepsis by 2-32%.

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Penicillin in Infants Weighing Two Kilograms or Less with Early-Onset Group B Streptococcal Disease

Cited by 127 publications

References 23 publications

Inflammatory Mediators in Umbilical Plasma from Neonates Who Develop Early-Onset Sepsis

Inflammatory Mediators in Umbilical Plasma from Neonates Who Develop Early-Onset Sepsis

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Randomized study of vaginal chlorhexidine disinfection during labor to prevent vertical transmission of group B streptococci

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