Streptococ B agalactiae pozitiv

In topicul povetsii nasterii mele o fata intreba la un moment dat despre situatia asta, acum pun cateva linii, caci cred ca in acel moment Macrina cauta un raspuns.

Acum am dat peste asta intamplator, doar pun aici.


It is exceptionally rare that a baby born at term with a normal birth weight
dies from a B strep infection. Those who are more vulnerable are premature
babies and small-for-date babies. Three studies published in authoritative
medical journals suggest that the use of a vaginal spray of chlorhexidine is
as effective as antibiotics. For mysterious reasons these studies are not
well known. I include the abstract of the most recent one. It is better not
to give eyes drops to the baby at birth and to rely on the results of an
antibiogram (in the unlikely occurence of an eye infection).
Abstract: -1- Facchinetti F, Piccinini F, Mordini B,Volpe A J Matern Fetal
Med 2002 Feb;11(2):84-8 Chlorhexidine vaginal flushings versus systemic
ampicillin in the prevention of vertical transmission of neonatal group B
streptococcus, at term.

OBJECTIVE: To investigate the efficacy of  intrapartum vaginal flushings
with chlorhexidine compared with ampicillin in preventing group B
streptococcus transmission to neonates.

METHODS: This was a randomized controlled study, including singleton
pregnancies delivering vaginally. Rupture of membranes, when present, must
not have occurred more than 6 h previously. Women with any gestational
complication, with a newborn previously affected by group B streptococcus
sepsis or whose cervical dilatation was greater than 5 cm were excluded. A
total of 244 group B streptococcus-colonized mothers at term (screened at
36-38 weeks) were randomized to receive either 140 ml chlorhexidine 0.2% by
vaginal flushings every 6 h or ampicillin 2 g intravenously every 6 h until
delivery. Neonatal swabs were taken at birth, at three different sites
(nose, ear andgastric juice).

RESULTS: A total of 108 women were treated with ampicillin and 109 with
chlorhexidine. Their ages and gestational weeks at delivery were similar in
the two groups. Nulliparous women were equally distributed between the two
groups (ampicillin, 87%; chlorhexidine, 89%). Clinical data such as birth
weight (ampicillin, 3,365 +/- 390 g;chlorhexidine, 3,440 +/- 452 g), Apgar
scores at 1 min (ampicillin, 8.4 +/- 0.9;chlorhexidine, 8.2 +/- 1.4) and at
5 min (ampicillin, 9.7 +/- 0.6; chlorhexidine,9.6 +/- 1.1) were similar for
the two groups, as was the rate of neonatal group B streptococcus
colonization (chlorhexidine, 15.6%; ampicillin, 12%). Escherichia coli, on
the other hand, was significantly more prevalent in the ampicillin (7.4%)
than in the chlorhexidine group (1.8%, p < 0.05).Six neonates were
transferred to the neonatal intensive care unit, including two cases of
early-onset sepsis (one in each group).

CONCLUSIONS: In this carefully screened target population, intrapartum
vaginal flushings with chlorhexidine in colonized mothers display the same
efficacy as ampicillin in preventing vertical transmission of group B
streptococcus. Moreover, the rate of neonatal E. colicolonization was
reduced by chlorhexidine.

Previous references:
-2 - Burman LG,et al. Prevention of excess neonatal morbidity associated
with group B streptococci. Lancet 1992; 340: 65-69
-3 - Taha TE, et al. Effect of cleansing the birth canal with antiseptic
solution. BMJ 1997; 315: 216-20.

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