title: Impact of perinatal practices for early-onset group B Streptococcal disease prevention.
abstract: BACKGROUND
  Prevention of residual cases of neonatal group B streptococcus (GBS) early-onset disease (EOGBS) has become a goal in the past decade. This study is aimed at evaluating changes in the incidence of EOGBS over a 9-year period after the implementation of a screening-based approach and comparing 2 different protocols for managing healthy-appearing at-risk newborns (ARNs).
  
  
  METHODS
  A screening-based strategy was introduced in Emilia-Romagna (Italy) in 2003. A prospective, cohort study was conducted from 2003 to 2011; culture-proven EOGBS cases were analyzed in 2 periods: period 1 (2003 to 2008) and period 2 (2009 to 2011). ARNs (≥35 weeks' gestation) were managed according to 2 different protocols: laboratory testing plus observation (period 1) was replaced with expectant observation alone (period 2).
  
  
  RESULTS
  Ninety-one EOGBS cases were observed (incidence rate: 0.26/1000 live births). The incidence in full-term babies declined from 0.30 (period 1) to 0.14/1000 live births (period 2, P = 0.04). Recto-vaginal screening cultures in full-term mothers increased significantly from 10/45 (period 1) to 10/14 (period 2, P = 0.002). EOGBS was diagnosed earlier in ARNs than in not-at-risk newborns (mean age 5.5 versus 14.5 hours, P = 0.007). There were no differences in age at diagnosis irrespective of whether ARNs were managed with laboratory testing plus observation (mean 3.5 hours, period 1) or with expectant observation alone (mean 2.4 hours, period 2).
  
  
  CONCLUSIONS
  When screening cultures were handled according to standard protocols, cases of EOGBS in full-term newborns simultaneously decreased. ARNs were diagnosed in a timely manner through both strategies. The clinical yield of laboratory testing was negligible.
authors: Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. berardi.alberto@policlinico.mo.it
authors: Alberto
authors: A
authors: Berardi
authors: Licia
authors: L
authors: Lugli
authors: Cecilia
authors: C
authors: Rossi
authors: Isotta
authors: I
authors: Guidotti
authors: Marcello
authors: M
authors: Lanari
authors: Roberta
authors: R
authors: Creti
authors: Enrica
authors: E
authors: Perrone
authors: Augusto
authors: A
authors: Biasini
authors: Fabrizio
authors: F
authors: Sandri
authors: Alessandro
authors: A
authors: Volta
authors: Mariachiara
authors: M
authors: China
authors: Laura
authors: L
authors: Sabatini
authors: Lucilla
authors: L
authors: Baldassarri
authors: Federica
authors: F
authors: Vagnarelli
authors: Fabrizio
authors: F
authors: Ferrari
authors: Emilia-Romagna
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D008297:Male; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*