Group B Streptococcus (GBS) and Neonatal Infections: The Case for Intrapartum Chemoprophylaxis

Abstract

EDITORIAL COMMENT: This paper presents important information concerning improvement in neonatal mortality and morbidity rates of infants born to mothers who are carriers of Group B streptococci by use of intrapartum penicillin treatment of these colonized women. These data indicate that to be effective chemotherapy must be given to the mother before delivery to minimize the risk of significant infection in the infant. Implementation of the protocol described in this paper could achieve significant improvement of neonatal results, but would not prevent stillbirths due to this infection. We still require introduction of a rapid sensitive antigen test for detection of GBS carrier status in early labour to identify those at risk patients who merit chemoprophylaxis -such a test could also be used to quickly identify GBS carrier status in patients with premature rupture of membranes where intrauterine infection may become established before the onset of labour. Summary: : At the Royal Women's Hospital, Melbourne over an 8-year period (1981–1988) all public antenatal patients were screened at 32 weeks' gestation for group B streptococcus (GBS). In a total of 30,197 livebirths there were no early onset neonatal GBS infections in infants of treated asymptomatic carrier mothers. By contrast there were 27 infections with 8 deaths in an unscreened control group of private patients (total livebirths 26,915). It is recommended that GBS screening occur antenatally at 28 weeks and that intrapartum chemoprophylaxis be offered at least to those carriers with obstetric risk factors.