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Keywords:

  • cost effectiveness;
  • early-onset neonatal infection;
  • group B streptococcus;
  • intrapartum antibiotic prophylaxis;
  • preterm rupture of membranes

Key content

  • Early-onset neonatal infection (infection arising within 72 hours of birth) is an important cause of morbidity and mortality and is often caused by Streptococcus agalactiae (group B streptococcus [GBS]).
  • Identifying and assessing risk factors for early-onset neonatal infection before and during labour and birth is integral to clinical management.
  • Intrapartum antibiotic prophylaxis (IAP) to prevent early-onset neonatal infection is effective when given to women with particular risk factors, including maternal GBS colonisation.
  • When IAP is given specifically to prevent early-onset neonatal infection with GBS the National Institute for Health and Care Excellence (NICE) recommends using benzylpenicillin.
  • Alternative antibiotic regimens are appropriate for women who are allergic to penicillin or where local microbiological surveillance data indicate antibiotic resistance.

Learning objectives

  • To be aware of the risk factors for early-onset neonatal infection.
  • To understand how IAP can reduce the risk of an early-onset neonatal infection.
  • To know which antibiotic to use for IAP of GBS.

Ethical issues

  • How should decisions about whether to administer IAP trade off the potential benefit to the baby of preventing an early-onset neonatal infection and potential harms to the woman, such as, allergic reactions and increased medicalisation of pregnancy?
  • How should decisions about the choice of antibiotics used in intrapartum prophylaxis take account of the risk of promoting antibiotic resistance?