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August 1996

Impact of Maternal Group B Streptococcal Screening on Pediatric Management in Full-Term Newborns

Author Affiliations

From the Division of General Pediatrics, Department of Pediatrics (Drs Peralta-Carcelen and Fargason), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (Ms Cliver and Dr Goldenberg), The University of Alabama at Birmingham; Biostatistics, American Medical Center Cancer Research Center, Denver, Colo (Dr Cutter); and Department of Pediatrics, Vanderbilt University, Nashville, Tenn (Dr Gigante).

Arch Pediatr Adolesc Med. 1996;150(8):802-808. doi:10.1001/archpedi.1996.02170330028005

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 new-borns 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.Arch Pediatr Adolesc Med. 1996;150:802-808