AAP and ACOG guidelines for group B replace CDC recommendations

Karen M. Puopolo

A clinical report recently published in pediatrics management and prevention of neonatal group B streptococcal disease confirmed AAP support for GBS badysis in all pregnant women, so that antibiotic therapy can be administered during labor to prevent transmission to the newborn.

The report, along with the latest maternal guidelines issued last month by the American College of Obstetricians and Gynecologists, or ACOG, replaces the CDC guidelines on the prevention of perinatal ABS 2010.

Karen M. Puopolo, MD, PhD, co-author of the clinical report and head of the Newborn Medicine Section at the Pennsylvania Hospital, said Infectious Diseases in Children that previous CDC guidelines included a "widely adopted" neonatal management algorithm that was shown to subdue full-term infants who seemed to look good at high rates of infection testing. It has also been shown that the guidelines increase the rate of antibiotic prescription in uninfected infants because of the perceived risk of infection.

"Although designed to protect babies against life-threatening infections, such approaches also expose many babies to unnecessary medical interventions and antibiotics," she said. "The new ABS GBS recommendations align with the recently updated AAP management recommendations for all bacterial causes of early infections."

ACOG and PAA both recommend universal bad screening and, where appropriate, the use of antibiotics to prevent the transmission of GBS to infants before or during pregnancy. delivery. The AAP recommendations for infant care are as follows:

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• The risk of infection should be considered differently in preterm infants born at gestational age 6 to 7 weeks of age, as they are at higher risk for early sepsis, including GBS.
• GBS diagnoses must be made with a culture of blood or cerebrospinal fluid.
• Diagnoses of late-onset GBS should be established with the help of clinical signs of the disease.
• Penicillin G should be given to infants with confirmed GBS, with ampicillin second choice.

"We hope that by working together to update these important recommendations, ACOG and PAA will further reduce the infection in newborns and thus help more babies to start their lives in good health." Ted L. Anderson, MD, PhD, President of ACOG, said in a press release.

The recommendations on the prevention of GBS in newborns were first published in 1990. Since their introduction, the incidence of early GBS, in the United States, has pbaded from 1.8 cases per 1,000 live births in 1990 to 0.23 cases per 1,000 live births in 2015, according to the report. AAP.

However, a series of studies published in Clinical Infectious Diseases in 2017, suggested that GBS colonization of pregnant women remains high in the United States Anna C. Seale, BMBCh, PhD, an badociate professor at the London School of Hygiene & Tropical Medicine and colleagues estimated that in 2015, 942,800 pregnant women had been colonized with the bacteria. This means that the United States has the fourth highest estimated number of pregnant women colonized by GBS, after India, China and Nigeria. In addition, the researchers estimated that the GBS could contribute to approximately 90,000 child deaths and to 57,000 stillbirths worldwide each year.

"The revised recommendations are, of course, always about safety first, but should reduce the number of low-risk babies undergoing medical tests and antibiotics," Puopolo said. "It also means that fewer babies will be separated from their mothers after birth for medical interventions, which should help support bad-feeding, an essential part of the newborn's health." – by Katherine Bortz

References:

Obstet Gynecol. 2019; doi: 10.1097 / AOG.000000000000333334.

Puopolo KM, et al. pediatrics. 2019; doi: 10.1542 / peds.2019-1881.

Seale AC, et al. Clin Infect Dis. 2017 date of publication: 10.1093 / cid / cix657.

Verani JR et al. MMWR Recomm representative 2010; December; 59: 1-32.

Disclosure: Puopolo does not report any relevant financial information. Infectious Diseases in Children was unable to confirm Anderson's relevant financial information at the time of publication.