Preventing Group B Streptococcus
Michel Odent, M.D.
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 dro ps to the baby at birth
and to rely on the results of an antibiogram
(in the unlikely occurence of an eye infection).
Abstract
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
se ps is 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 grou ps . Nulliparous women were
equally distributed between the two grou ps
(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 grou ps
, 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 se ps is (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.
References:
-1 - Facchinetti F, Piccinini F, Mordini B,Volpe
A J Matern Fetal Med 2002 Feb;11(2):84-8.
-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.
Reprinted with permission from Mothering.com
For several decades Michel Odent has been
instrumental in influencing the history of
childbirth and health research.
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