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Neonatologist, obstetrician to review updates to perinatal group B strep guidance :

September 25, 2019

Editor's note:The 2019 AAP National Conference & Exhibition will take place from Oct. 25-29 in New Orleans.

When it came time to update 2010 consensus guidelines on the prevention of perinatal group B streptococcal (GBS) disease, the Centers for Disease Control and Prevention (CDC) asked the Academy and the American College of Obstetricians and Gynecologists (ACOG) to take the lead.

The result was two separate but aligned documents outlining recommendations for neonatal care and obstetric care.

The new guidance will be discussed during a session titled “Management of Infants at Risk for Group B Streptococcal Disease” (S4225) from 4-5:30 p.m. Monday, Oct. 28 in room 352 of the convention center. 

The new AAP clinical report (http://bit.ly/2keYgqY) will be summarized by Karen M. Puopolo, M.D., Ph.D., FAAP, a lead author of the report and a member of the AAP Committee on Fetus and Newborn. ACOG’s recommendations (http://bit.ly/2Xka5OH) will be discussed by Neil S. Silverman, M.D., one of the document’s authors and clinical professor of obstetrics and gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine at UCLA.

Dr. Puopolo said she first will explain why the guidelines needed to be revised and why the decision was made to create two separate documents.

“One thing that marks these revisions is they are informed by data, but they are also motivated by the multitude of comments and questions that had come directly from clinicians to CDC, and they were crafted to be very responsive to what clinicians told us they needed to know,” she said.

The biggest change for neonatal care providers is to ensure that the way they evaluate newborns at risk of GBS disease is aligned with recommendations in the 2018 AAP clinical report Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis (http://bit.ly/2FX05Az).

“The new AAP document tells the clinician very clearly that this is an area where there’s always uncertainty and lays out three approaches, all of which have literature to support them, all of which have pluses and minuses, all of which were laid out in the December 2018 report on management of early-onset sepsis,” said Dr. Puopolo, chief of the Section on Newborn Medicine at Pennsylvania Hospital and associate professor of pediatrics at the University of Pennsylvania Perelman School of Medicine.

Birth hospitals should look at their resources and structure of care to determine which option they think would work best in their setting, she added.

Among the major changes for obstetricians are when to screen pregnant women to determine if they are GBS-colonized and how to manage pregnant women with antibiotic allergy.

“I do hope the documents are very helpful to clinicians,” Dr. Puopolo said, “because in the end, our goal is to give excellent clinical care to keep our mothers and babies safe.”

For more coverage of the 2019 AAP National Conference & Exhibition, visit http://bit.ly/AAPNationalConference19.

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