2. Evaluate clinical features and laboratory support
3. Empirical or specific antimicrobial agents
4. Share information between obstetrical and pediatric/ family medicine providers
5. Post-partum follow-up
Examples of some highly effective routine preventive measures for perinatal infections
1. Neonatal tetanus
Maternal tetanus vaccination/booster
2. Neonatal ophthalmia with topical agents:
1% silver nitrate
3. Hepatitis B screening and vaccination
Results of HBV immunization in Taiwan
Mass immunization program
1984: Newborns of HBsAg(+) mothers
1986: All newborns
1987: All preschoolers
Sero-prevalence of 6-years old cohort :
Year tested HBsAg(+) AntiHBc(+)/HbsAg(-)
1989 10.5 % 25 %
1991 6.3 % 16 %
1993 1.7 % 4.3 %
(Hsu etal:J Infect Dis 1999;179:367-70)
Incidence of hepato-cellular-carcinoma in Taiwanese children since routine HBV immunization in 1984
Prevention of Maternal-to-Child-Transmission of HIV/AIDS is possible
A 1994 study in the USA showed that ZDV given during pregnancy and perinatally decreased MTCT from 22.6% to 7.6%
Since then, the rate of MTCT in resource-rich countries is further decreased from 9.8% to 1-3%
Even in developing countries, anti-retroviral therapy can decrease the rate of transmission by 30-50%, to as low as 6.5% in one study.
Components of an effective prevention program
1. Understanding of biology and epidemiology
2. Setting strategic priorities
3. Investing in material and human resources
4. Provide adequate monitoring and evaluation
Should antibiotics be used routinely for pre-term, pre-labor rupture of membranes ?
1. Infants born prematurely and/or following prolonged rupture of membranes are at increased risk of disease and death.
2. Maternal infection or colonization with various genital pathogens increases the risk of maternal, fetal, and neonatal disease and mortality.
Review of the ORACLES studies
Two randomized, controlled studies evaluating the risk/benefits of broad spectrum antibiotics for pre-term, pre-labor rupture of membranes. ( erythromycin, amoxicillin+clavulanate, both drugs, or placebo, for 10 days or until delivery )
Enrolled more than 11,000 pregnant women at high risk: mean gestation = 31-32 weeks, 75% received antenatal corticosteroids.
Outcome measurements: Maternal infection, duration of pregnancy, fetal or neonatal death, chronic lung disease, major cerebral abnormality on ultra-sound.
(S Kenyon etal:the Lancet Vol 357, march21,2001:979-94)
Antibiotics for pre-term, pre-labor rupture of membrane: Results of the ORACLES I&II studies
Case study: Prevention of perinatal group B Streptococcal (GBS) infections
1. Infects mainly newborns, pregnant women and adults with underlying medical conditions, especially diabetes.
2. 10-30% of pregnant women are asymptomatic carriers in the rectal-vaginal areas. A few develop urinary tract infection, amnionitis, endometritis, wound infections, still births and premature delivery.
Prevention of perinatal Group B Streptococcal (GBS) infections
3. Infants born to GBS carrier mothers have a 30-fold increase of infection.
4 . GBS in neonates:
Early onset disease (< 7 days): 80% of cases, 5-20% mortality