Liberal Diagnosis and Treatment of Intrauterine Infection Reduces Early-Onset Neonatal Group BStreptococcal Infection but not Sepsis byOther Pathogens

摘要

Objective:Comparison of the incidence and case fatality of early-onset group B streptococcus sepsisand sepsis caused by other pathogens in neonates after change of management of intrauterineinfection.Methods:All infants delivered from 1988 through 1997 at a gestational age ≥ 24 weeks with abirth weight ≥ 500 gram without lethal congenital abnormalities were eligible for inclusion. Infantsdelivered by cesarean section before the onset of labor or rupture of membranes were excluded.During the first period (1988–1991) intrauterine infection was diagnosed by a temperature > 38℃,during the second period (1992–1997) this diagnosis was made at a lower temperature (≥ 37.8℃)or by fetal tachycardia ≥ 160/min. Treatment of intrauterine infection was similar during bothperiods with 3 × 2 gram amoxicillin and 1 × 240 mg gentamicin every 24 hours intravenously duringlabor. Prophylactic treatment during labor was only given to women with a history of an earlierinfant with early-onset group B streptococcus sepsis.Results:During the first period 6,103 infants were included, during the second period 8,504.Intrauterine infection was diagnosed and treated more often in the second period (7.1% vs. 2.6%).The incidence of early-onset group B streptococcus sepsis was significantly lower in the secondperiod than in the first period [0.2% vs. 0.4%; OR 0.5 (0.3–0.9)] and survival without disabilityhigher [80% vs. 52%; OR 4.5 (1.4–16.5)]. However, in both periods the overall incidence of neonatalsepsis (3.6% vs. 3.5%) and overall mortality because of sepsis (14.3% vs.13.1%) were similar.Conclusions:Although the early detection of clinical signs of intrauterine infection might havebeen effective for the prevention of serious sequelae of early-onset group B streptococcus sepsis theoverall incidence and mortality from neonatal sepsis remained unchanged. Evaluation of preventivemeasures for early-onset group B streptococcus sepsis should always take the incidence of neonatalsepsis caused by other pathogens into account. Infect. Dis. Obstet. Gynecol. 8:143–150, 2000.