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

J Perinatol. 2013 Mar;33(3):198-205. doi: 10.1038/jp.2012.96. Epub 2012 Jul 19.


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.

MeSH terms

  • Age of Onset
  • Antibiotic Prophylaxis
  • Asymptomatic Diseases
  • Centers for Disease Control and Prevention, U.S.
  • Female
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control
  • Male
  • Neonatal Screening
  • Practice Guidelines as Topic*
  • Sepsis / epidemiology*
  • Sepsis / prevention & control
  • Streptococcal Infections / epidemiology*
  • Streptococcal Infections / prevention & control
  • Streptococcus agalactiae*
  • United States