Deepa Ranganathan

Racial differences in respiratory-related neonatal mortality among very low birth weight infants.

OBJECTIVE To examine racial differences in the secular trends in respiratory-related neonatal mortality among very low birth weight (VLBW) infants in the United States, temporally associated with surfactant availability. DESIGN Comparison of time trends in African American and non-Hispanic white (NHW) VLBW infants of cause-specific neonatal mortality and neonatal and infant mortality for 2 consecutive 3-year periods. RESULTS From 1985 to 1988 there was no racial difference in the rate of decline of each mortality outcome. From 1988 to 1991 rates of decline in neonatal mortality caused by respiratory distress syndrome and by all respiratory causes were significantly greater for NHWs compared with African Americans. However, the rate of decline in nonrespiratory neonatal mortality was similar for African Americans and NHWs. Compared with African American VLBW infants, NHWs had a greater rate of decline in both neonatal (31% vs 20%; P <.01) and infant mortality (32% vs 21%; P <.01) during this period. CONCLUSIONS Between 1988 and 1991, declines in neonatal mortality risks caused by respiratory distress syndrome and all respiratory causes were greater for NHW infants than for African American VLBW infants. The decline in nonrespiratory mortality risk showed no racial differences. These findings suggest possible racial disparities in timely access or racial differences in the efficacy of respiratory treatments for VLBW infants.

Group B streptococcus: to culture or not to culture?

OBJECTIVE:To determine if universal Group B Streptococcus (GBS) culturing and antibiotic prophylaxis of obstetric patients decreased the incidence of neonatal early-onset GBS sepsis and mortality and maternal chorioamnionitis.STUDY DESIGN:A time series observational study was conducted to compare the cohort of all obstetric patients delivering at the University of Chicago neonatal center from January 1989 through December 1993, before a GBS surveillance policy existed, with the cohort delivering January 1994 through December 1996, after initiation of a GBS policy. Included in the policy were universal GBS cultures at 28 weeks’ gestation, antibiotic prophylaxis at the time of labor for all those with positive cultures and for all with risk factors of preterm delivery, preterm premature rupture of membranes, prolonged rupture of membranes greater than 18 hours, and a previous child affected by GBS or maternal fever in labor. Predictor variables were GBS culturing and antibiotic usage; outcome variables were incidence of GBS sepsis and mortality in the neonates and maternal chorioamnionitis. χ-squared and Fisher exact analyses were used with p < 0.05 being significant.RESULTS:Before the GBS policy, there were 16,272 deliveries with a 2.24/1000 deliveries rate of early-onset GBS sepsis (n = 35); after initiating the GBS policy, 9130 deliveries occurred with an early-onset GBS sepsis rate of 2.29/1000 (n = 20). Early-onset GBS sepsis case fatality rates before and after initiation of the policy were 14.3% and 0%, respectively (p = 0.09). Antibiotic use almost doubled (relative risk = 1.84; confidence interval, 1.74 to 1.93, p < 0.001) over the two time periods, and the relative risk of chorioamnionitis decreased to 0.95 (confidence interval, 0.73 to 0.99, p = 0.04).CONCLUSION:Despite universal GBS culturing and very liberal use of antibiotics in labor, we were unable to effect a statistically significant change in the rate of early-onset GBS sepsis or mortality, and there was only a slightly decreased chorioamnionitis rate.

Racial Differences in Secular Trends in Respiratory-Related Neonatal Mortality among VLBW Infants in the US

Racial Differences in Secular Trends in Respiratory-Related Neonatal Mortality among VLBW Infants in the US

Maternal Age-Adjusted Birth Prevalence of Down Syndrome Is Lower in States with Higher Levels of Per Capita Income

Maternal Age-Adjusted Birth Prevalence of Down Syndrome Is Lower in States with Higher Levels of Per Capita Income

Effect of Short (< 12 months) Interpregnancy Intervals on the Risk of Cause-Specific Infant Mortality Rates in the US

Effect of Short (< 12 months) Interpregnancy Intervals on the Risk of Cause-Specific Infant Mortality Rates in the US

Increased Use of Maternal Intra-Partum Antibiotics is Not Associated with a Reduction in Morbidity of Early-Onset GBS (GBS) Infections: But It Does Expose a Lot More Women to Ampicillin |[dagger]| 1471

Maternal chemoprophylaxis with intra-partum antibiotics (IPA), has been increasingly enouraged over the past several years in an attempt to reduce the incidence of GBS infections. We wondered what impact these exhortations had on the incidence, morbidity, and mortality of GBS infections in our institution.

Obstetric management and Group B Streptococcal sepsls: Have we made progress? Has it made a difference? • 1339

Obstetric management and Group B Streptococcal sepsls: Have we made progress? Has it made a difference? • 1339

Obstetric Management and Group B Streptococcal Sepsis

Intrapartum administration of antibiotics (IPA) to pregnant women at the time of delivery has been demonstrated to reduce neonatal colonization with Group B Streptococci (GBS). On this basis, indications for the use of IPA have been progressively broadened over the past several years in the United States. We wondered what impact these recommendations have had in our own institution. Specifically, we addressed two questions: 1) For which conditions, if any, has the use of IPA increased over the past several years in our maternal population? 2) Has the increased use of IPA, if noted, reduced the number of infants with GBS infection?