Incidence of group B streptococcus early-onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: a multicenter retrospective study - 22/11/23

Doi : 10.1016/j.ajog.2023.10.035

Jia Ming Low, MBBS, MMed, MCI ^a,^b,^⁎ , Jan Hau Lee, MBBS, MCI ^c,^d, Henry P. Foote, MD ^e, Christoph P. Hornik, MD, PhD, MPH ^e,^f, Reese H. Clark, MD ^g, Rachel G. Greenberg, MD, MB, MHS ^e,^f
^a Department of Neonatology, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore, Singapore
^b Department of Paediatrics, Yong Loo Lin School of Singapore, National University of Singapore, Singapore, Singapore
^c Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
^d Singhealth-Duke NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
^e Department of Pediatrics, Duke University, Durham, NC
^f Duke Clinical Research Institute, Durham, NC
^g Pediatrix Medical Group, Inc., Sunrise, FL

^∗Corresponding author: Jia Ming Low, MBBS, MMed, MCI.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 22 November 2023

Abstract

Background

The difference in the incidence of early-onset sepsis caused by group B streptococcus among term neonates whose mothers received first-line vs second-line intrapartum prophylaxis is poorly described.

Objective

This study aimed to compare the incidence of group B streptococcus early-onset sepsis among term neonates born to mothers who receive first-line, second-line, or no intrapartum antibiotics and to describe the short-term and survival outcomes of neonates who developed group B streptococcus early-onset sepsis stratified by maternal antepartum prophylaxis.

Study Design

This was a retrospective review of electronic medical records. We queried the Pediatrix Medical Group Clinical Data Warehouse to evaluate the outcomes of term neonates born to group B streptococcus positive mothers between 2003 and 2020 and compared the incidence and outcomes of neonates with group B streptococcus early-onset sepsis whose mothers received first-line vs second-line or no intrapartum prophylaxis.

Results

Among the 496,180 neonates, 104,196 (21%) were born to mothers who were group B streptococcus positive. Of 97,983 mothers who were group B streptococcus positive with adequate prenatal antibiotic documentation, 49,234 (50%), 12,679 (13%), and 36,070 (37%) received first-line, second-line, and no intrapartum prophylaxis, respectively. The incidence of group B streptococcus early-onset sepsis among all neonates with maternal group B streptococcus carriage was 0.22% (231/104,196). Neonates whose mothers received second-line intrapartum antibiotics and no antibiotics had a higher risk for group B streptococcus early-onset sepsis infection than those whose mothers received first-line intrapartum antibiotics (adjusted odds ratio, 4.12; 95% confidence interval, 2.66–6.38 and adjusted odds ratio, 3.80; 95% confidence interval, 2.66–5.44, respectively). There was no statistically significant difference in the risk for group B streptococcus early-onset sepsis among neonates born to mothers who received second-line vs no antibiotics (adjusted odds ratio, 0.92; 95% confidence interval, 0.64–1.33).

Conclusion

Neonates exposed to second-line maternal group B streptococcus prophylaxis had an increased risk for group B streptococcus early-onset sepsis when compared with those exposed to first-line maternal group B streptococcus prophylaxis. There was no statistically significant difference in group B streptococcus early-onset sepsis incidence between second-line antibiotic prophylaxis and no antibiotics in mothers with group B streptococcus carriage.

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Key words : database, group B streptococcus, maternal intrapartum antibiotics, neonates

Plan

Introduction

Materials and Methods

Results in the context of what is known

Clinical implications

Strengths and limitations

Research implications

Conclusion

	R.G.G. and C.P.H. report receiving support from industry for research services (conflict-of-interest/). The other authors report no conflict of interest.
	J.M.L. was supported by the National University Health System Clinician Scientist Program 2.0 under award number NCSP2.0/2023/PVO/LJM. J.H.L.’s institution received research funding from the National Medical Research Council, Singapore, and the Thrasher Research Fund, United States. H.P.F. was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under award number T32HD094671. None of the funders were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
	Institutional review board waiver of consent was obtained (Pro00113571).
	The computer code for analysis and the data sets generated during and/or analyzed during this study are available from the corresponding author upon reasonable request.
	Cite this article as: Low JM, Lee JH, Foote HP, et al. Incidence of group B streptococcus early-onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: a multicenter retrospective study. Am J Obstet Gynecol 2023;XX:x.ex–x.ex.