Postnatal penicillin prophylaxis of early-onset group B streptococcal infection in term newborns. A preliminary study.

BACKGROUND: Early-onset group B Streptococcal disease (EOGBSD) is a serious but preventable neonatal infection. Maternal intrapartum antibiotic prophylaxis (IAP) does not prevent all cases of the disease. Management of asymptomatic neonates of GBS colonized mothers is problematic. AIMS: The objective of this prospective study was to determine whether administration of intramuscular penicillin at birth to a strictly defined group of term newborns of GBS colonized mothers is an effective and safe method to prevent EOGBSD. METHODS: A protocol for management of full-term infants born to GBS colonized mothers was created. Either an abnormality of blood count or presence of more than one obstetric risk factor were chosen as the indication criteria for administering postnatal antibiotic prophylaxis (PAP). RESULTS: The study sample consists of 250 newborns (11.5% of all term infants). PAP was administered in 39 cases. Indication criteria included leucocytosis in 37 cases, leucopenia in 1 case and obstetric risk factors in 1 case. There was no case of clinically manifest infection, and no case of sepsis either suspect or proven. CONCLUSIONS: The authors suggest that the strategy of selective PAP using penicillin, may be an effective and safe method in order to reduce morbidity and mortality from streptococcal infections. They recommend a combination of IAP and selective PAP.

Evaluation of transcutaneous bilirubinometry in preterm infants of gestational age 32-34 weeks.

AIMS: The aim of this prospective study was to evaluate the accuracy of transcutaneous bilirubinometry using the Minolta Air-Shields JM-103 device in preterm newborns of gestational age 32-34 weeks, and to identify the most appropriate measurement site. METHODS: Transcutaneous bilirubin (TcB) measurements were performed over forehead, sternum and abdomen, if total serum bilirubin (TSB) had to be determined on clinical indication in neonates of selected gestational age. TSB levels were measured in a clinical laboratory using direct spectrophotometry. In order to assess transcutaneous bilirubinometry accuracy, differences between TSB and TcB, their CI 95%, and correlation coefficients (r) between TcB and TSB were evaluated. RESULTS: The study group consisted of 44 infants, including 6 very low birth weight (VLBW) neonates. The correlations between transcutaneous and laboratory values were found to be significant and close. Minimal differences were observed when measured over sternum. The measurements over forehead had a tendency to underestimate TSB levels. CONCLUSIONS: Noninvasive measurement by Minolta JM-103 demonstrated significant accuracy. The authors recommend measurements over sternum or abdomen in premature infants born within 32-34 gestational weeks as a reliable and accurate neonatal hyperbilirubinemia screening test. Transcutaneous bilirubinometry has the potential to reduce the number of blood samplings, thus reducing neonatal pain and discomfort, parental distress and medical care cost.