Dan Waisman1, Ayala Gover2, Michal Molad2, Reuven Kedar3, Avi Rotschild2, William E Benitz4. 1. Department of Neonatology, Carmel Medical Center and Faculty of Medicine, Technion - Israel Institute of Technology, 7 Michal St, Haifa, Israel. dwaisman@technion.ac.il. 2. Department of Neonatology, Carmel Medical Center and Faculty of Medicine, Technion - Israel Institute of Technology, 7 Michal St, Haifa, Israel. 3. Department of Obstetrics and Gynecology, Carmel Medical Center, and Faculty of Medicine, Technion - Israel Institute of Technology, Michal St, Haifa, Israel. 4. Stanford University School of Medicine, Division of Neonatal & Developmental Medicine, Palo Alto, CA, 94304, USA.
Abstract
OBJECTIVE: To quantify effects of different strategies for decreasing neonatal early onset GBS sepsis (EOGBS) in Israel. STUDY DESIGN: A risk allocation model for EOGBS among infants ≥ 35w was adapted to Israeli data. Effects of strategies for antepartum (APS) and intrapartum (IPS) screening, and intrapartum (IAP) and/or postpartum antibiotic prophylaxis (PAP) were calculated. RESULTS: Estimated EOGBS attack rates (AR) with APS in 90%, IAP in 90%, may reduce AR to 0.18/1000. A rapid intrapartum test would further decrease AR to 0.16/1000, while reducing IAP from 21.3 to 12.5% of women. For babies with risk factors and GBS+ who do not receive IAP, further risk reduction could be achieved by PAP. CONCLUSION: IAP remains the main intervention to decrease EOGBS. IAP and PAP together may reduce EOGBS present incidence by 40%. Combining rapid intrapartum screening with selective IAP and selective PAP for remaining gaps, would be the most efficient strategy.
OBJECTIVE: To quantify effects of different strategies for decreasing neonatal early onset GBS sepsis (EOGBS) in Israel. STUDY DESIGN: A risk allocation model for EOGBS among infants ≥ 35w was adapted to Israeli data. Effects of strategies for antepartum (APS) and intrapartum (IPS) screening, and intrapartum (IAP) and/or postpartum antibiotic prophylaxis (PAP) were calculated. RESULTS: Estimated EOGBS attack rates (AR) with APS in 90%, IAP in 90%, may reduce AR to 0.18/1000. A rapid intrapartum test would further decrease AR to 0.16/1000, while reducing IAP from 21.3 to 12.5% of women. For babies with risk factors and GBS+ who do not receive IAP, further risk reduction could be achieved by PAP. CONCLUSION: IAP remains the main intervention to decrease EOGBS. IAP and PAP together may reduce EOGBS present incidence by 40%. Combining rapid intrapartum screening with selective IAP and selective PAP for remaining gaps, would be the most efficient strategy.