Impact of maternal group B streptococcal screening on pediatric management in full-term newborns
M. Peralta-Carcelen, C. A. Fargason Jr, S. P. Cliver, G. R. Cutter, J. Gigante and R. L. Goldenberg
Department of Pediatrics, University of Alabama at Birmingham, USA.
BACKGROUND: The American Academy of Pediatrics strategy to prevent
early-onset neonatal sepsis with group B streptococcus (GBS) relies on
maternal antepartum GBS cultures, while the American College of Obstetrics
and Gynecology strategy does not. OBJECTIVE: To evaluate the impact of the
2 strategies on the care of asymptomatic full-term newborns.
DESIGN/SETTING: Self-administered survey mailed to a national random sample
of US pediatricians who were members of the American Academy of Pediatrics.
PARTICIPANTS: A total of 461 members of the American Academy of Pediatrics
who routinely care for newborns. MAIN OUTCOME MEASURE: Self-report of
diagnostic and treatment strategies for asymptomatic full-term newborns who
were born under different clinical scenarios. Maternal risk factors,
antepartum maternal GBS screening status, and maternal treatment with
intrapartum antibiotics were varied across the scenarios. RESULTS:
Pediatricians treating asymptomatic full-term newborns born to risk
factor-negative mothers reported ordering tests (63.3% in GBS-positive
cases vs 6.7% with GBS unknown; P = .001) and antibiotics (21.5% in
GBS-positive cases vs 0.9% with GBS unknown; P = .001) more frequently when
presented with a positive maternal GBS screening result. Maternal
intrapartum treatment had little impact on pediatric practice when risk
factors were absent. In risk factor-positive mothers, pediatricians
reported an increase in their antibiotic usage in response to a positive
maternal GBS screen (61.8% in GBS-positive cases vs 36.9% with GBS unknown;
P = .001). In risk factor-positive mothers with unknown results of GBS
screening, use of intrapartum antibiotics increased the number of
pediatricians who reported that they would prescribe antibiotic therapy.
CONCLUSIONS: Obstetrical strategies to decrease the risk of neonatal GBS
sepsis increase pediatric services provided to full-term healthy newborns.
This increase in services by pediatric practices is likely to be greater
with the screening-based strategy recommended by the American Academy of
Pediatrics.
