Impact of maternal group B streptococcal screening on pediatric management in full-term newborns.
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.


METHODS
Self-administered survey mailed to a national random sample of US pediatricians who were members of the American Academy of Pediatrics.


METHODS
A total of 461 members of the American Academy of Pediatrics who routinely care for newborns.


METHODS
Self-report of diagnostic and treatment strategies for asymptomatic full-term newborns 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.
Peralta-Carcelen
M
M
Department of Pediatrics, University of Alabama at Birmingham, USA.
Fargason
C A
CA
Cliver
S P
SP
Cutter
G R
GR
Gigante
J
J
Goldenberg
R L
RL
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011295:Prenatal Care / Q000379:methods; D012307:Risk Factors; D012955:Societies, Medical; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission; D013292:Streptococcus agalactiae; D011795:Surveys and Questionnaires; D014481:United States
D000900:Anti-Bacterial Agents