title: Early-onset group B Streptococcus sepsis in high risk neonates born after prolonged rupture of membranes.
abstract: BACKGROUND
  According to the U.S. Centers for Disease Control guidelines, prolonged rupture of membranes mandates intrapartum antimicrobial prophylaxis for group B Streptococcus whenever maternal GBS status is unknown.
  
  
  OBJECTIVE
  To evaluate the local incidence, early detection and outcome of early-onset GBS sepsis in neonates born at 35-42 weeks gestation after PROM to women with unknown GBS status who were not given intrapartum antimicrobial prophylaxis.
  
  
  METHODS
  During a 1 year period we studied all neonates born beyond 35 weeks gestation with maternal PROM > or =18 hours, unknown maternal GBS status and without prior administration of IAP. Complete blood count, C-reactive protein, blood culture and polymerase chain reaction amplification of bacterial 16S rRNA gene were performed in blood samples collected immediately after birth. Unfavorable outcome was defined by one or more of the following: GBS bacteremia, clinical signs of sepsis, or positive PCR.
  
  
  RESULTS
  Of the 3616 liveborns 212 (5.9%) met the inclusion criteria. Only 12 (5.7%) of these neonates presented signs suggestive of sepsis. PCR was negative in all cases. Fifty-eight neonates (27.4%) had CRP > 1.0 mg/dl and/or complete blood count abnormalities, but these were not significantly associated with unfavorable outcome. Early-onset GBS sepsis occurred in one neonate in this high risk group (1/212 = 0.47%, 95% CI 0.012-2.6).
  
  
  CONCLUSIONS
  In this single-institution study, the incidence of early-onset GBS sepsis in neonates born after PROM of 18 hours, unknown maternal GBS status and no intrapartum antimicrobial prophylaxis was 0.47%.
authors.affiliation: Department of Neonatology, Meyer Children's Hospital, Rambam Health Care Campus, Israel. makhoul@rambam.health.gov.il
authors.forename: Imad R
authors.initials: IR
authors.lastname: Makhoul
authors.forename: Hannah
authors.initials: H
authors.lastname: Sprecher
authors.forename: Raneen
authors.initials: R
authors.lastname: Sawaid
authors.forename: Peter
authors.initials: P
authors.lastname: Jakobi
authors.forename: Tatiana
authors.initials: T
authors.lastname: Smolkin
authors.forename: Polo
authors.initials: P
authors.lastname: Sujov
authors.forename: Imad
authors.initials: I
authors.lastname: Kassis
authors.forename: Shraga
authors.initials: S
authors.lastname: Blazer