Kogelman, R. (Rosalie) (2017) De richtlijn preventie van neonatale GBS-sepsis bij prematuren : Praktijkvariatie binnen een algemene kinderafdeling. thesis, Medicine.
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Abstract
Objective: The Dutch national guideline ‘prevention of neonatal GBS-sepsis’ provides information over whether certain new-borns are eligible for clinical observation possibly in combination with treatment with empirical intravenous broad-spectrum antibiotics for the prevention of neonatal GBS-sepsis. The guideline prescribes that neonates of GBS-carriers or of mothers whose GBS-status in unknown, which are born after a period of 32 to 35 weeks gestation, will imediately have to start with the broad-spectrum antibiotics treatment. This with the exception of children of mothers who have had adequate antibiotic prophylaxis administration and in addition show no clinical signs of an infection. The aim of this study is to check whether the implementation of this GBS-guideline has an effect on the clinical course of the neonate for those who are prematurely born after a pregnancy of 32 to 35 weeks. Methods: By means of a retrospective status research the implementation of the GBS-guideline was checked from 2012 until the end of 2016, for all neonates born after a gestational period of 32 to 35 weeks and admitted at the neonatal ward of Isala Hospital in Zwolle. Subsequently an expert panel examined record of blood cultures and the clinical course on clinical suspicion of infection and whether there was a case of neonatal sepsis The expert panel was formed by a pediatrician/neonatologist and two general pediatricians. A unison judgement of at least two experts was considered the ‘golden standard’. Results: During the five-year period 335 prematures with a gestational age of 32 to 35 weeks where admitted tot the neonatal ward. Of these, 109 (32,5%) where maternal GBS-carriers and 44 (13,1%) had an unknown maternal status. After exclusion of children born after a primary sectio caesarea before rupture of the membranes (n=65), where the GBS-guideline is inapplicable, there where 88 of the 335 (26,3%) found eligible for treatment following the GBS-guideline. In according tot the guideline 83,8% (n=73) found eligible for treatment with antibiotics, while in practice 26 (29,5%) were treated with antibiotics. Eventually, 6,8% (n=6) had neonatal sepsis, one of which was proven with a positive blood culture. There was a deviation from the guideline with 56,8% (n=51) in which 2,3% (n=2) there was a case of overtreatment (wrong use of antibiotics) and with 55,7% (n=49) undertreament (no use of antibiotics). The inter-observer agreement of the clinical symptoms on which the decision to initiate the use of antibiotics was reasonable (kappa 0,530), the inter-observer variation over the determination of clinical sepsis, on the other hand, was good (kappa 0,758). Conclusion: The implementation of the GBS-guideline is moderate. Only 21,9% mothers and 42% of neonates where treated adequately. The’re no indications that this has led to poor outcomes. Pediatricians did not take into account the pre-treatment of the mother in their decision-making process to initiate broad-spectrum antibiotics. The focus was especially put on clinical signs of infection. The variation in practices considering the implementation of the guideline ‘prevention of neonatal GBS-sepsis’ for prematures of a gestational age of 32 to 35 weeks is considerable. The inter-observer variation of the judgement of clinical symptoms seems to play a important role in this.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor and Bekhof, Dr. J. kinderarts and Afdeling Kindergeneeskunde and Instelling Isala, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1817 |
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