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BACKGROUND: Prenatal screening for infectious diseases and infant hepatitis B virus (HBV) vaccination are vital to protect the health of newborns. The Centers for Disease Control and Prevention (CDC) recommend first and third trimester screening for HIV and syphilis, first trimester screening for HBV, third trimester screening for group B streptococcus (GBS), and syphilis testing at delivery . CDC guidelines also recommend universal birth dose HBV vaccination for infants. Recent studies indicate that informing providers of their prenatal screening rates for infectious conditions can increase screening. We reviewed birth records from 2013 to characterize screening and vaccination practices among local prenatal providers and birth hospitals.
METHODS: A random sample of 205 births among Philadelphia residents (1.3%) was drawn from 2013 birth certificates for the six birth hospitals in Philadelphia County. Hospital-specific samples were weighted according to the proportion of Philadelphia births delivered at each hospital. Within each mother-infant pair, medical records were reviewed for adherence to screening recommendations. Infant charts were reviewed for HBV vaccine administration for eligible infants (>2500 grams at birth). Prenatal screening and vaccination practices were compared between hospitals using chi-square analysis.
RESULTS: Chart reviews were completed for 201 birth pairs (98.0%). Forty seven women (23.4%) did not receive prenatal care or lacked prenatal care documentation. Among 154 mothers with at least one documented prenatal care visit, 87.0%, 77.9%, and 70.1% were tested for HIV, syphilis, and HBV, respectively, during the first trimester. For third trimester testing, 50.0% of mothers were screened for HIV and syphilis, and 64.9% received GBS testing. At delivery, syphilis testing was conducted for 56.7% of mothers, with testing rates differing significantly between hospitals (range 28.9-100%, p<0.0001). Among 184 eligible infants, HBV vaccine was given to 176 (95.7%), with administration varying between hospitals (range 83.3-100%, p = 0.009).
CONCLUSIONS: Hospitals demonstrated strong adherence to recommendations for the administration of HBV vaccine to newborns. First trimester testing for HIV and syphilis was also high; however, rates of HBV screening, third trimester testing, and syphilis testing at delivery were all inadequate. Adherence to prenatal screening, syphilis testing at delivery, and hepatitis B vaccination guidelines varied across facilities. Missed opportunities for prenatal care and screening during prenatal care are issues that need to be addressed. PDPH will present these findings to local prenatal care providers and birth hospitals and work on means to improve adherence.