Evaluation of neonatal sepsis screening in a tropical area. Part II: Evaluation of intrapartum chemoprophylaxis protocol

ABSTRACT

The authors report on an analysis of a chemoprophylaxis protocol at the University Hospital of Guadeloupe in the Caribbean. This study comprised 6,060 consecutive deliveries and was initiated to assess the application of an intrapartum chemoprophylaxis protocol, evaluate the results, and try to identify possible necessary modifications to the existing protocol. Although more than 90 percent of women had at least one bacterial screening (vaginal or urinary) during the last trimester of pregnancy, approximately 75 percent of mothers who were heavily colonized group B streptococcus (GSB) at delivery were not detected by this systematic screening. As is also reported in other tropical areas where a great portion of nenonatal sepsis occurs in term babies, low birthweight was not a specific risk factor in this study when controlling for other major risk factor such as fever and premature rupture of membranes. Intrapartum chemoprophlaxis was associated wiyh an approximate three fold decrease in the risk of GBS neonatal bacteraemia among at risk deliveries. The results suggest that, in our tropical context, prolonged rupture of membranes of at least 12 hours' duration should be considered as a cause for intrapartum chemopropylaxis as it accounted for the majority of neonatal bacteraemia that escaped the existing protocol. (AU)