Adherence to three different strategies to prevent early onset GBS infection in newborns |
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| Institution: | 1. Amsterdam UMC Vrije Universiteit Amsterdam, VU Medical Center, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands;2. Department of Child Health, TNO, P.O. Box 3005, Leiden, 2301 DA, The Netherlands;3. The Netherlands Department of Clinical Psychology, Vrije Universiteit, Van Der Boechorststraat 1, Amsterdam, 1081 BT, The Netherlands;4. Amsterdam Public Health (APH) Research Institute, Van Der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands;1. Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia;2. Sydney Institute of Women, Children and their Families, Sydney Local Health District, NSW Australia;3. Charles Perkins Centre, University of Sydney, NSW, Australia;4. Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Australia;5. Red Nose Australia;6. SANDS Australia;7. Stillbirth Foundation Australia;8. Still Aware;9. SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia;1. Department of Perinatal Health, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico;2. Data Mining Coordinator, Carlos Slim Foundation, Mexico City, Mexico;3. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, United States;4. Vanderbilt University, Nashville, TN, United States;5. Bixby Center for Global Reproductive Health, University of California San Francisco, CA, United States;6. Division of Determinants and Challenges of Health Systems, Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico;1. Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia;2. School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Brisbane, Australia;3. Mater Health Services, Raymond Tce, South Brisbane, Australia;4. Departments of Family Medicine and Clinical Skills, University of Split School of Medicine, Split, Croatia;5. Cochrane Croatia, University of Split School of Medicine, Split, Croatia;1. Charles Darwin University, Australia;2. Charles Darwin University & Edith Cowan University, Australia;3. Politeknik Kesehatan Kartini, Bali, Indonesia;4. Politeknik Kesehatan Kemenkes Denpasar, Indonesia;1. Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia;2. Griffith University, School of Medicine and Gold Coast University Hospital, Gold Coast, QLD, Australia;3. Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia;4. SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia;5. Burnet Institute, Melbourne, Victoria, Australia;6. Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia;7. The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia;8. Women and Babies Research, University of Sydney, Sydney, NSW, Australia;9. Clinical Excellence Commission, Department of Health, Sydney, NSW, Australia;10. Clinical Excellence Queensland, Department of Health, Brisbane, QLD, Australia |
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| Abstract: | ProblemDespite the introduction of preventive guidelines, no decrease in the incidence of early onset infection was observed.BackgroundEarly onset group B streptococcal (EOGBS) infection is an important cause of neonatal morbidity and mortality.AimOur study was conducted to determine adherence to three guideline-based group B streptococcus (GBS) preventive strategies.MethodsA prospective experimental study clustered by obstetric collaboration region was performed between March 2013 and August 2014 among midwives, obstetricians and paediatricians in the Netherlands. At baseline, the three regions operated according to the Dutch preventive strategy (founded on the risk-based strategy) in order to prevent EOGBS infection, whereas in the study period they followed either the risk-based, the combination or the Dutch strategy. Adherence was measured prospectively per pregnant woman, using predefined core elements of each preventive strategy: identification of risk factors, maternal GBS screening, application of intrapartum antibiotic prophylaxis and observation of the child. Data about adherence to the core elements were collected from medical records, maternal questionnaires and laboratory test results.FindingsIn the three regions, a total of 121 care providers and 1562 women participated.We found an overall adherence of 90% to the risk-based strategy, 57% to the combination strategy and 89% to the Dutch strategy. Adherence to a strategy in case women had EOGBS risk factors was below 20% in all strategies.DiscussionThe majority of women with EOGBS risk factors did not receive the care prescribed by any of three preventive strategies and were not treated optimally.ConclusionThe risk-based and the Dutch strategy are the recommended strategies for implementation. |
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| Keywords: | Early-onset group B streptococcus Guideline adherence Intrapartum antibiotic prophylaxis Screening |
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