Prevention of neonatal group B streptococcal infection.
The optimal clinical strategy to prevent neonatal group B streptococcal infection has not been established. The Maternal-Fetal Medicine Units Network assessed the feasibility of a randomized clinical trial to compare the effectiveness of two methods of prevention of streptococcal infection. The attack rates of early-onset group B streptococcal disease were estimated for the following: 1) a hypothetical program of universal prenatal screening and selective intrapartum chemoprophylaxis, and 2) a hypothetical program of selective intrapartum chemoprophylaxis based on clinical risk factors. Sample size requirements were calculated for a clinical trial to detect a significant difference in attack rates between the two hypothetical programs. Similar low attack rates using both strategies would require extremely large sample sizes to detect differences between programs. Until a satisfactory, rapid diagnostic test for intrapartum group B streptococcal carrier status is developed and clinical strategies are tested in populations with varying carriage frequencies, institutions will need to individualize their approaches to prevent early-onset neonatal group B streptococcal disease.
Landon
M B
MB
Ohio State University College of Medicine, Magee-Women's Hospital, University of Pittsburgh.
Harger
J
J
McNellis
D
D
Mercer
B
B
Thom
E A
EA
D000465:Algorithms; D005240:Feasibility Studies; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae