title: Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines.
abstract: BACKGROUND
  Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in New Zealand five years after the publication of national risk-based GBS prevention guidelines.
  
  
  METHODS
  Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48 h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life.
  
  
  RESULTS
  There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per 1000 live births.
  
  
  CONCLUSIONS
  Ten years after a similar survey and five years after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate.
authors.affiliation: Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Darlow
authors.affiliation: Department of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Lesley
authors.initials: L
authors.lastname: Voss
authors.affiliation: University of Auckland, Auckland, New Zealand.|Kidz First and Starship Children's Hospitals, Auckland, New Zealand.
authors.forename: Diana R
authors.initials: DR
authors.lastname: Lennon
authors.affiliation: Queensland Children's Medical Research Institute, Children's Health Queensland, South Brisbane, Queensland, Australia.
authors.forename: Keith
authors.initials: K
authors.lastname: Grimwood
mesh_terms: D005260:Female; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D009520:New Zealand / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D062486:Public Health Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013292:Streptococcus agalactiae
keywords: Streptococcus agalactiae; newborn; prevention and control; sepsis; surveillance and monitoring