Firmino F. Rubaltelli,
Neonatologist
University of Florence School of Medicine,
Carlo Dani, and Giovanna Bertini
Send letter to journal:
Re: Prevention of early-onset group B streptococcal disease.
rubaltelli{at}unifi.it Firmino F. Rubaltelli, et al.
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The paper of Berardi et al. (1) regarding group B Streptococcal (GBS) Infections in a Northern Region of Italy adds important observations on this leading cause of neonatal bacterial infections. The authors emphasize that eleven of 30 infants with confirmed early-onset disease (EOD) either had no clinical signs or were mildly ill. In addition, it has been reported that most mothers of infants with EOD (17 of 22) were screened GBS – negative (1). However, EOD may occur in infants born to GBS - negative women even if screening is appropriate (2,3). We would like to make a comment and report our own data from another Italian Region. Regarding the study of Berardi et al (1), the comment is that optimal bacterial culture methods were available from only 1 of 26 laboratories participating in the study during 2003, and in 12 during 2005. It is our opinion that more and more we must rely on protein chain reaction (PCR) techniques in order to confirm suspicion of EOD.
In the largest maternity hospital (AOUC) of Tuscany, a Central Region of Italy, we monitored EOD in three different time periods. In the years 1990-1996, when prenatal screening for GBS was 63 % and intrapartum chemoprophylaxis was 59%, EOD was 8/14,833 (0.54 ‰) while in 1997-2003 when prenatal screening for GBS was 75%, and risk based approach was introduced making intrapartum chemoprophylaxis around 80%, EOD was 7/23,606 (0.29 ‰). From June 1st 2004 until now, according to the reports of Wendel et al. (4) and Velaphi et al. (5), our department has started a combined protocol including both the screening-based and risk-based approach along with single-dose penicillin neonatal prophylaxis at birth. During this period of time ~12,000 neonates were born in our hospital (AOUC) and just one case of EOD was detected in a neonate with meconium aspiration syndrome born to a mother with high fever and infection symptoms. It is possible that this was a prenatal infection. However, the infant has survived without any problems observed with ongoing follow-up. Even though this is an observational report, we consider the use of sodium G penicillin administration at birth an effective enhancement in the prevention of EOD without evident harmful effects to the neonate such as increased bacterial infections from different microorganisms or allergic reactions. It would be interesting to know the results obtained in other hospitals applying the same prophylaxis, even if an international double blind randomized study is worthwhile.
REFERENCES
1. Berardi A, Lugli L, Baronciani D, Creti R, Rossi K, Ciccia M, Gambini L, Mariani S, Papa I, Serra L, Tridapalli E, Ferrari F. Group B streptococcal infections in a northern region of Italy. Pediatrics. 2007;120/3/2487-e493
2. Pinto NM, Soskolne EI, Pearlman MD, Faix RG. Neonatal early-onset group B streptococcal disease in the era of intrapartum chemoprophylaxis: residual problems. J Perinatol. 2003; 23: 265-71
3.Share L, Chaikin S, Pomeranets S, Kiwi R, Jacobs M, fanaroff AA. Implementation of guidelines for preventing early onset group B streptococcal infection. Semin Perinatol. 2001;25 :107-113
4.Wendel GD, Leveno KJ, Sanchez PJ, Jackson GL, McIntire DD, Siegel JD. Prevention of neonatal group B streptococcal disease: A combined intrapartum and neonatal protocol. Am J Obstet Gynecol 2002;186:618-26
5 Velaphi S, Siegel JD, Wendel GD Jr, Cushion N, Eid WM, Sanchez PJ. Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy. Pediatrics 2003; 111: 541-7
Conflict of Interest:
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Prevention of early-onset group B streptococcal disease.
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