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18-03-2013 | Infectious disease | Article

Physical exam alone identifies neonatal group B streptococcal sepsis


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medwireNews: A simplified physical examination can identify newborns with early-onset group B streptococcal (EOGBS) sepsis and obviates the need for laboratory tests, results of a prospective study confirm.

Importantly, the approach is not associated with an increased use of antibiotics; in fact, there was a 58% relative reduction in the need for antibiotic treatment during the study period.

"For asymptomatic neonates at risk for GBS sepsis, laboratory tests seem to offer no advantage over standardized physical examination alone," Sergio Demarini (IRCCS Burlo Garofolo, Trieste, Italy) and team write in The Journal of Pediatrics. "This simpler strategy would result in a lower number of laboratory tests, no significant delay in identifying infants with signs of possible sepsis, and no increase in antibiotic use."

The traditional work-up in cases of suspected neonatal GBS sepsis is to perform a complete blood count, including a differential white cell count and blood culture, and to monitor the neonate during a period of observation involving a physical examination.

Recently, however, recommendations have changed and indicate that healthy term infants born to mothers with a confirmed GBS infection can be safely managed with observation for at least 48 hours alone. Demarini and team conducted the population-based study during a regional policy change on GBS management.

Two 12-month study periods were examined - involving more than 8000 live births in each - with the traditional sepsis work-up performed in the first period (2004-2005) and physical examination alone in the second period (2005-2006). The latter involved examining infants' skin appearance, respiratory rate, and respiratory muscle retractions at regular 1-hour intervals initially, then every 2 hours, and then every 4 hours, for the first 2 days after birth.

Data analysis was restricted to infants born at term, with 7628 born in the first study period and 7611 in the second study period.

A similar percentage of women were confirmed with GBS colonization in the first and second years of the study (19.7 and 19.8%), and a similar percentage received intrapartum antibiotic prophylaxis. Antibiotics were given to 1.2% of infants in the first study year, but to only 0.5% in the second study year. Clinical signs and risk factors were reported as the main reasons that the attending physicians did not consider antibiotic treatment necessary.

"Even beyond the mandatory 48-hour observation period, no infant became symptomatic during the first week of life," Demarini and team remark.

By Sara Freeman, medwireNews Reporter

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