The prevention of early-onset neonatal group B streptococcus infection: technical report from the New Zealand GBS Consensus Working Party.
OBJECTIVE
Early-onset neonatal group B streptococcus (GBS) is the leading infectious cause of disease in newborn babies. Since intrapartum antibiotics interrupt vertical GBS transmission, this is now a largely preventable public health problem. An important first step is to develop (then implement) nationally, agreed prevention policies.


METHODS
Representatives from the New Zealand College of Midwives, the Paediatric Society of New Zealand, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal New Zealand College of General Practitioners, and the Homebirth Association met to review evidence that will assist in the formulation of GBS prevention policies that are most suitable for New Zealand.


RESULTS
The Technical Working Group noted that (i) no strategy will prevent all cases of early-onset GBS infection, (ii) intrapartum antibiotics are associated with rare, but serious, adverse effects, (iii) concerns remain over developing antibiotic resistance, (iv) an economic analysis is required to help inform policy, (iv) reliable bedside diagnostic tests for GBS in early labour are not yet available and (iv) the most important determinant of effectiveness will be compliance with a single national prevention policy.


CONCLUSIONS
As an interim measure a GBS risk-based prevention strategy is recommended. This exposes the least numbers of women and their babies to antibiotics, while virtually preventing all deaths from GBS sepsis. Continuing education of health professionals and pregnant women, auditing protocol compliance, tracking adverse events amongst pregnant women, and national surveillance of neonatal sepsis and mortality rates and antibiotic resistance are necessary for the strategy's success.
New Zealand College of Midwives, Christchurch, New Zealand.
Norma
N
Campbell
Alison
A
Eddy
Brian
B
Darlow
Peter
P
Stone
Keith
K
Grimwood
D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D024881:Drug Resistance, Bacterial; D005260:Female; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007743:Labor, Obstetric; D009520:New Zealand; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D013292:Streptococcus agalactiae