Implementation of a cost effective strategy to prevent neonatal infection by group B-hemolytic streptococcus

Current prevention in the Netherlands of early onset group B- hemolytic
streptococcus infection (EOGBS) within the first week of life can be improved.
Perinatal mortality among children with EOGBS is 9.2%.
Intrapartum Antibiotic Prophylaxis (IAP) is effective in prevention of vertical
transmission of GBS from mother to child. It is not clear which pregnant women
need treatment with IAP.
Different prevention strategies are available, based on either screening during
pregnancy on GBS carriership with the mother (screening strategy), risk
factors during labour associated with EOGBS (risk factor strategy) or a
combination of screening and risk factors (combination strategy).
A theoretical modelstudy of TNO showed the combination strategy to be most
costeffective strategy in the Netherlands. The riskfactor strategy was cost
effective too. The screening strategy, as in use in the USA, has the highest
effect in reduction of morbidity and mortality at highest costs.
The current Dutch guideline seemed not very cost effective. The modelstudy was
based on 100% adherence of the strategy. The question remains what cost
effectiveness of the different strategies is in daily practice.
In this study three strategies will be implemented in three regions and
compared on realtime cost effectiveness.

To find the most cost effective GBS prevention strategy to reduce neonatal
morbidity and mortality by GBS for the Netherlands.

Implementation study.
Intervention: Implementation of three different GBS prevention strategies in
three regions in the Netherlands.

Pregnant women will be included from the 30 th week of pregnancy onward. In the
combination strategy a culture will be taken between 35 and 37 weeks of
pregnancy to detect GBS carriership. The culture will be taken during a regular
pregnancyconsult. There is no need for the pregnant women for a extra visit.
During the next consult de test result will be discussed with the pregnant
woman. There are no risks related to taking the culture.
Intrapartum antibiotic prophylaxis will be provided to GBS carriers with a risk
factor in the combination strategy and to all pregnant women with a risk factor
in the riskfactor strategy.
Antibiotic prophylaxis given intravenous, demands hospital admittance during
labour. In the third strategy, the revised Dutch guideline, no extra actions
are performed.
Pregnant women are asked to fill a form on decisional conflict during
pregnancy. After delivery mothers are asked to fill a form on satisfaction.