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Implementation of Perinatal Group B Streptococcal Prevention Guidelines

The U.S. Centers for Disease Control and Prevention (CDC) launched the Emerging Infections Program (EIP) to develop centers of excellence in infectious disease surveillance and applied public health research in selected state health departments. The Oregon EIP is participating in the study described below.

Implementation of Perinatal Group B Streptococcal Prevention Guidelines Among Infants with Invasive Early-Onset Infections

Traceback Investigation - Abstract

Background: Group B streptococcus (GBS) emerged as the leading infectious cause of neonatal morbidity and mortality in the 1970s. Despite very effective prevention interventions issued in 1996 that are well carried out at a population level, GBS continues to be the leading cause of early-onset neonatal sepsis in the United States. A greater understanding is needed of the cases of early-onset GBS that continue to occur.

Objectives: Evaluation will of the implementation of perinatal GBS prevention guidelines to identify implementation failures among early-onset GBS cases and to assess factors that may contribute to a false negative antenatal GBS screen.

Design: Retrospective review of laboratory-confirmed early‐onset GBS cases.

Participants: The review evaluates cases identified through the ABCs system during a two-year time period (2008-2009). A case of early-onset invasive GBS disease is defined as isolation of GBS from a normally sterile site (e.g. blood, cerebrospinal fluid) in a resident 0-6 days of age in the ABCs surveillance catchment areas. An estimated 300-350 cases occurred during the two-year evaluation period.

Data collection: Variables of interest for the evaluation are those related to the implementation and effectiveness of the GBS prevention guidelines. Sources of data include: labor and delivery medical records, prenatal medical records, interviews with clinic managers and prenatal care providers, and clinical laboratory records. Data abstracted from medical/laboratory records and obtained through interviews that are recorded on standardized data-collection forms.

Data analysis: Data analysis will be conducted by the CDC using SAS, version 9.2. Preliminary analyses have already been performed, including description of cases and identification of missed prevention opportunities. Statistical analyses are pending.

Results: A total of 312 cases were identified in 2008‐2009. Data are complete for 95% of these cases (n=297). Over a quarter of these cases were born prematurely (<37 weeks). Missed prevention opportunities identified includes; no prenatal care, failure to screen, lack of communication, and insufficient intrapartum prophylaxis. Statistical results are pending.

Sponsor: U.S. Centers for Disease Control & Prevention, US Department of Health & Human Services
Start date: January 2010
End date: December 2011

To see all Oregon Emerging Infections Program special studies go to EIP special studies.