English summary: INCIDENCE, CLINICAL PRESENTATION AND PREVENTION OF EARLY-ONSET GROUP B STREPTOCOCCAL DISEASE IN NEONATES: PRESENT SITUATION IN THE GREATER HELSINKI AREA

Background

An increased incidence of neonatal early-onset group B streptococcal disease (EOGBS) was observed in Helsinki University Central Hospital (HUCH) in 2005. The preventive strategy was changed to a risk factor based approach to identify candidates for intrapartum antibiotic prophylaxis. The previous strategy had been based partly on screening high-risk mothers on arrival at the hospital and partly on risk factors. We studied the incidence, implementation of prophylaxis and clinical presentation before and after the change of the preventive strategy.

Methods

The incidence of EOGBS was reviewed among neonates born in HUCH during the years 2005-2007. The strategy for implementation of prophylaxis was studied on the basis of the consumption of penicillin G in the delivery departments. The clinical presentation of infected neonates and the prophylaxis received by the mothers was studied from the patient records.

Results

The incidence of EOGBS was 1.00 per 1000 live births before and 0.47 after the change in the preventive strategy. Less than 5 percent of the mothers received intrapartum antibiotic prophylaxis before and about 17-25 percent after the change. Of the EOGBS cases, 19% (6/31) were preterm. Mothers of the infected neonates had not received prophylaxis.

Conclusions

After adopting the risk factor based preventive strategy, the incidence of EOGBS was halved in HUCH. Calculation of the consumption of penicillin G in the delivery departments is a useful tool for evaluating implementation of the prophylaxis. Not only the choice of the preventive strategy but also the implementation and constant education of the personnel are essential for the prevention of EOGBS.

Kiitokset ylilääkäri, dosentti Outi Lyytikäiselle Terveyden ja hyvinvoinnin laitokselta sekä avusta GBS-potilaiden tunnistamisessa eri tietojärjestelmistä että käsikirjoituksen kommentoinnista. Kiitokset hygieniahoitaja Anu Hintikalle Jorvin sairaalasta avusta äitien sairaskertomustietojen läpikäymisessä ja ATK-koordinaattori Minna Donkorille Lasten ja Nuorten sairaalasta avusta GBS-tautiin sairastuneiden lasten tietojen keräyksessä sairaalan poistoilmoitusrekisteristä. Kiitämme myös tulosyksikön johtaja Jari Petäjää Naisten- ja lastentautien tulosyksiköstä, pediatri Tarja Rautasta Jorvin sairaalasta ja mikrobiologi Petteri Carlsonia aktiivisuudesta GBS-tapausten lisääntymisen tunnistamisessa ja tautitapausten alkuvaiheen selvittelyissä Jorvin sairaalassa.