title: Intrapartum evidence of early-onset group B streptococcus.
abstract: OBJECTIVE
  To estimate if neonates with early-onset group B streptococcus (GBS) sepsis have clinical evidence of fetal infection during labor or at delivery.
  
  
  METHODS
  Retrospective cohort study of all neonates diagnosed with GBS sepsis by culture and clinical findings within the first 72 hours of life from January 1, 2000, through December 31, 2008, at Parkland Health and Hospital System. Medical records were reviewed and maternal, neonatal, and delivery data were ascertained. These neonates then were compared with all neonates delivered during the same time period.
  
  
  RESULTS
  During the study period, 143,384 live-born neonates were delivered at our institution; 94 were diagnosed with early-onset GBS sepsis. The majority of these neonates (n=93) were diagnosed with early-onset GBS within the first hour of life. Neonates with early-onset GBS sepsis had a significant increase in preterm delivery, cesarean delivery (total and for fetal distress), 1- and 5-minute Apgar scores of 3 or lower, umbilical cord pH less than 7.0, and a base deficit of 12 mmol/L or higher. In addition, nulliparity differed between those with early-onset GBS and those without (74% compared with 33%, P<.001) as did chorioamnionitis rates (62% compared with 8%, P<.001).
  
  
  CONCLUSIONS
  We believe that these findings are compelling evidence that fetuses with early-onset GBS may have signs of sepsis peripartum. We hypothesize that these data support the concept that early-onset GBS represents a spectrum of infection that often precedes birth.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA. carmen.tudela@utsouthwestern.edu
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Tudela
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stewart
authors.forename: Scott W
authors.initials: SW
authors.lastname: Roberts
authors.forename: George D
authors.initials: GD
authors.lastname: Wendel
authors.forename: Irene A
authors.initials: IA
authors.lastname: Stafford
authors.forename: Donald D
authors.initials: DD
authors.lastname: McIntire
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Sheffield
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D047928:Premature Birth / Q000382:microbiology; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents