GuidelinesPerspective

AAP, ACOG group B strep guidelines replace CDC recommendations

Karen Puopolo, MD
Karen M. Puopolo

A clinical report recently published in Pediatrics on the management and prevention of neonatal group B streptococcal disease affirmed the AAP’s support for testing all pregnant women for GBS so that antibiotic therapy can be given during labor to prevent transmission to newborns.

The report, along with recent maternal guidelines published last month by the American College of Obstetricians and Gynecologists, or ACOG, replaces the CDC’s 2010 Perinatal GBS Prevention guidelines.

Karen M. Puopolo, MD, PhD, co-author of the clinical report and chief of the section of newborn medicine at Pennsylvania Hospital, told Infectious Diseases in Children that the previous CDC guidelines included a “widely adopted” neonatal management algorithm that has been shown to subject otherwise well-appearing term infants to high rates of testing for infection. The guidelines have also been shown to increase the rate of antibiotic prescriptions in uninfected infants because of a perceived risk for infection.

“Although performed to protect babies from a potentially life-threatening infection, such approaches also exposed many babies to unneeded medical interventions and antibiotics,” she said. “The new AAP GBS recommendations align with recently updated AAP management recommendations for all-bacterial causes of early-onset infection.”

ACOG and AAP both recommend universal maternal screening and, when appropriate, antibiotics to prevent GBS transmission to infants either before or during delivery. The AAP recommendations for infant care include the following:

Newborn with mother in hospital 
Source: Shutterstock

  • The risk for infection should be considered differently in preterm infants born at 34 6/7 weeks’ gestational age and younger because these infants are at higher risk for early-onset sepsis, including GBS.
  • GBS diagnoses should be made with blood or cerebrospinal fluid culture.
  • Diagnoses of late-onset GBS should be made using clinical signs of illness.
  • Penicillin G should be given to infants with confirmed GBS, with ampicillin as a second choice.

“We hope that by working together to update these important recommendations, ACOG and AAP will further reduce infection among newborns, helping more babies have a healthy start to their lives,” Ted L. Anderson, MD, PhD, president of ACOG, said in a press release.

Recommendations on GBS prevention among newborns were first issued in 1990. Since their introduction, the incidence of early-onset GBS in the United States dropped from 1.8 cases per 1,000 live births in 1990 to 0.23 cases per 1,000 live births in 2015, according to the AAP.

However, a series of studies published in Clinical Infectious Diseases in 2017 suggested that GBS colonization of pregnant women remains high in the U.S. Anna C. Seale, BMBCh, PhD, an associate professor at the London School of Hygiene & Tropical Medicine, and colleagues estimated that in 2015, 942,800 pregnant women were colonized with the bacteria. This means the U.S. has the fourth highest estimated number of pregnant women colonized with GBS, following India, China and Nigeria. Additionally, the researchers estimated that GBS may contribute to approximately 90,000 infant deaths and 57,000 stillbirths every year around the world.

“The revised recommendations are, of course, still aimed at safety first but should result in fewer low-risk babies having medical testing and antibiotics,” Puopolo said. “This also means fewer babies will be separated from their mothers after birth for medical interventions, which should help support breastfeeding, which is a critically important part of newborn health.” – by Katherine Bortz

References:

Obstet Gynecol. 2019;doi:10.1097/AOG.0000000000003334.

Puopolo KM, et al. Pediatrics. 2019;doi:10.1542/peds.2019-1881.

Seale AC, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix657.

Verani JR, et al. MMWR Recomm Rep. 2010;Dec;59:1-32.

Disclosures: Anderson and Puopolo report no relevant financial disclosures.

Karen Puopolo, MD
Karen M. Puopolo

A clinical report recently published in Pediatrics on the management and prevention of neonatal group B streptococcal disease affirmed the AAP’s support for testing all pregnant women for GBS so that antibiotic therapy can be given during labor to prevent transmission to newborns.

The report, along with recent maternal guidelines published last month by the American College of Obstetricians and Gynecologists, or ACOG, replaces the CDC’s 2010 Perinatal GBS Prevention guidelines.

Karen M. Puopolo, MD, PhD, co-author of the clinical report and chief of the section of newborn medicine at Pennsylvania Hospital, told Infectious Diseases in Children that the previous CDC guidelines included a “widely adopted” neonatal management algorithm that has been shown to subject otherwise well-appearing term infants to high rates of testing for infection. The guidelines have also been shown to increase the rate of antibiotic prescriptions in uninfected infants because of a perceived risk for infection.

“Although performed to protect babies from a potentially life-threatening infection, such approaches also exposed many babies to unneeded medical interventions and antibiotics,” she said. “The new AAP GBS recommendations align with recently updated AAP management recommendations for all-bacterial causes of early-onset infection.”

ACOG and AAP both recommend universal maternal screening and, when appropriate, antibiotics to prevent GBS transmission to infants either before or during delivery. The AAP recommendations for infant care include the following:

Newborn with mother in hospital 
Source: Shutterstock

  • The risk for infection should be considered differently in preterm infants born at 34 6/7 weeks’ gestational age and younger because these infants are at higher risk for early-onset sepsis, including GBS.
  • GBS diagnoses should be made with blood or cerebrospinal fluid culture.
  • Diagnoses of late-onset GBS should be made using clinical signs of illness.
  • Penicillin G should be given to infants with confirmed GBS, with ampicillin as a second choice.

“We hope that by working together to update these important recommendations, ACOG and AAP will further reduce infection among newborns, helping more babies have a healthy start to their lives,” Ted L. Anderson, MD, PhD, president of ACOG, said in a press release.

Recommendations on GBS prevention among newborns were first issued in 1990. Since their introduction, the incidence of early-onset GBS in the United States dropped from 1.8 cases per 1,000 live births in 1990 to 0.23 cases per 1,000 live births in 2015, according to the AAP.

However, a series of studies published in Clinical Infectious Diseases in 2017 suggested that GBS colonization of pregnant women remains high in the U.S. Anna C. Seale, BMBCh, PhD, an associate professor at the London School of Hygiene & Tropical Medicine, and colleagues estimated that in 2015, 942,800 pregnant women were colonized with the bacteria. This means the U.S. has the fourth highest estimated number of pregnant women colonized with GBS, following India, China and Nigeria. Additionally, the researchers estimated that GBS may contribute to approximately 90,000 infant deaths and 57,000 stillbirths every year around the world.

“The revised recommendations are, of course, still aimed at safety first but should result in fewer low-risk babies having medical testing and antibiotics,” Puopolo said. “This also means fewer babies will be separated from their mothers after birth for medical interventions, which should help support breastfeeding, which is a critically important part of newborn health.” – by Katherine Bortz

References:

Obstet Gynecol. 2019;doi:10.1097/AOG.0000000000003334.

Puopolo KM, et al. Pediatrics. 2019;doi:10.1542/peds.2019-1881.

Seale AC, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix657.

Verani JR, et al. MMWR Recomm Rep. 2010;Dec;59:1-32.

Disclosures: Anderson and Puopolo report no relevant financial disclosures.

    Perspective
    Richard F. Jacobs

    Richard F. Jacobs

    The revised guidelines from the AAP and ACOG on GBS prevention are a refinement to better target the highest risk group of babies. The significant reduction in early-onset disease that followed the 2010 recommendations for maternal screening, preventive care and treatment has been impressive. These new modifications to the guidelines offer all providers of maternal and infant care the opportunity to focus our efforts to continue to reduce the incidence of this potentially fatal infection in the highest risk group of babies.

    As with all AAP and ACOG guidelines, it also emphasizes the need for all pregnant women to have good prenatal care — a national goal. The adoption and implementation of these new guidelines are exciting, and they could lead to a further reduction in this potentially deadly disease.

    • Richard F. Jacobs, MD
    • Infectious Diseases in Children Chief Medical Editor
      Professor emeritus
      University of Arkansas for Medical Sciences

    Disclosures: Jacobs reports no relevant financial disclosures.