Neonatal early-onset sepsis evaluations among well-apearing infants: projected impact of changes in CDC GBS guidelines

Objective: To determine (a) the proportion of asymptomatic infants born at >= 35 weeks gestation evaluated for early-onset sepsis (EOS) and exposed to postnatal antibiotics; (b) reasons for and outcomes of the evaluations, and (c) anticipated changes when applying the Centers for Disease Control and Prevention (CDC) 2010 guidelines to this study population. Study Design: Retrospective cohort study of infants born at >= 35 weeks gestation in 2008-2009 in a large maternity center. Result: Out of the 7226 infants that met the study criteria: 1062 (14.7%) were evaluated for EOS and half of those evaluated, received empiric antibiotics. 70.4% of evaluations were performed owing to maternal intrapartum fever, but 23% were prompted by inadequate Group B Streptococcus (GBS) prophylaxis alone. Three cases of blood culture-proven infection were identified. Conclusion: Improved approaches are needed to identify asymptomatic infants who are at risk for EOS to decrease unnecessary evaluations and antibiotic exposure. Transition to the 2010 CDC GBS guidelines may eliminate a quarter of EOS evaluations among these infants. Journal of Perinatology (2013) 33, 198-205; doi:10.1038/jp.2012.96; published online 19 July 2012