AAP reaffirms antibiotics for group B strep during delivery

July 17, 2019

Updated practice guidelines published by the American Academy of Pediatrics (AAP) aim at managing infants at risk for Group B streptococcal disease.

The American Academy of Pediatrics (AAP) has issued a clinical report on managing infants at risk for Group B streptococcal (GBS) infection that reaffirms its support of universal testing of pregnant women so that appropriate antibiotics can be administered during delivery to protect the newborn from GBS infection. The AAP guidelines support the American College of Obstetricians and Gynecologists (ACOG) in replacing former practice guidelines last issued in 2010 by the Centers for Disease Control and Prevention (CDC).

According to the AAP report, GBS is the most common cause of neonatal early-onset sepsis (within the first 6 days of life) and a significant cause of late-onset sepsis (between 7 and 89 days of life). Maternal intrapartum prophylaxis with antibiotics is the only effective means of preventing early-onset GBS in infants. There is no effective strategy for preventing late-onset GBS. Treating mothers for maternal colonization of GBS during pregnancy and/or delivery prevents the transmission of GBS from mother to infant, which can lead to sepsis, meningitis, and pneumonia.

The ACOG has updated its guidance to now routinely screen mothers for GBS between 36 0/7 and 37 6/7 weeks of gestation. According to ACOG’s recent committee opinion on early -onset GBS disease in newborns, 50% of pregnant women colonized with GBS will pass the bacteria along to their newborns. Vertical transmission occurs during labor or after rupture of membranes. Without intrapartum antibiotic prophylaxis, “1% to 2% of these newborns will develop early-onset GBS. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intra-amniotic infection, young maternal age, and maternal black race,” ACOG says.

 

Recommendations for universal screening of pregnant women for GBS and Intrapartum antibiotic prophylaxis were first introduced in 1990. Since then, national incidence of early-onset GBS disease has dropped from 1.8 cases per 1000 live births in 1990 to 0.23 cases per 1000 live births in 2015.