Group B Streptococcus early-onset disease and observation of well-appearing newborns

• Published in: PloS one 2019-03, Vol.14 (3), p.e0212784-e0212784
• Main Authors: Berardi, Alberto, Spada, Caterina, Reggiani, Maria Letizia Bacchi, Creti, Roberta, Baroni, Lorenza, Capretti, Maria Grazia, Ciccia, Matilde, Fiorini, Valentina, Gambini, Lucia, Gargano, Giancarlo, Papa, Irene, Piccinini, Giancarlo, Rizzo, Vittoria, Sandri, Fabrizio, Lucaccioni, Laura
• Format: Article
• Language: English
• Subjects: Age; Age of Onset; Antibiotics; Babies; Biology and Life Sciences; Birth; Care and treatment; Causation; Disease control; Disease prevention; Disease susceptibility; Exposure; Female; Fever; Gestation; Health risks; Humans; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - microbiology; Infant, Newborn, Diseases - prevention & control; Infants; Intervention; Italy - epidemiology; Laboratories; Male; Mechanical ventilation; Medicine and Health Sciences; Meningitis; Mortality; Neonatal diseases; Neonates; Newborn babies; Newborn infants; Pediatric research; Pediatrics; People and Places; Physical examinations; Premature infants; Prophylaxis; Prospective Studies; Risk factors; Risk management; Sepsis; Signs and symptoms; Strategy; Streptococcal infections; Streptococcal Infections - epidemiology; Streptococcal Infections - prevention & control; Streptococcus; Streptococcus agalactiae; Streptococcus infections; Surveillance; Ventilation; Working groups
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0212784

International guidelines lack a substantial consensus regarding management of asymptomatic full-term and late preterm neonates at risk for early-onset disease (EOS). Large cohorts of newborns are suitable to increase the understanding of the safety and efficacy of a given strategy. This is a prospective, area-based, cohort study involving regional birth facilities of Emilia-Romagna (Italy). We compared cases of EOS (at or above 35 weeks' gestation) registered in 2003-2009 (baseline period: 266,646 LBs) and in 2010-2016, after introduction of a new strategy (serial physical examinations, SPEs) for managing asymptomatic neonates at risk for EOS (intervention period: 265,508 LBs). There were 108 cases of EOS (baseline period, n = 60; intervention period, n = 48). Twenty-two (20.4%) remained asymptomatic through the first 72 hours of life, whereas 86 (79.6%) developed symptoms, in most cases (52/86, 60.5%) at birth or within 6 hours. The median age at presentation was significantly earlier in the intrapartum antibiotic prophylaxis (IAP)-exposed than in the IAP-unexposed neonates (0 hours, IQR 0.0000-0.0000 vs 6 hours, IQR 0.0000-15.0000, p