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B. Other categories of illnesses: 2. Collagen-Vascular Illnesses
4. Generalized |
The Approach to Neonatal Group B Strep InfectionTraci Brumund, MD Introduction: The incidence of sepsis (2-4 per 1000 newborns) is doubled when there is maternal colonization with GBS. GBS disease can have a mortality rate as much as 50% from sepsis, pneumonia and meningitis. If colonization of mothers is recognized and treated early, the incidence of invasive GBS disease can be reduced to 0.7 per 1000. The Identification of Patients at Risk: Screen Mothers and Infants: A. Screening Mothers: Current recommendations: screen all pregnant women for GBS colonization by obtaining vaginal and rectal cultures from mothers between 35 and 37 weeks of gestation, and treat with antibiotics at the time of delivery. Former recommendations: mothers screened, and if indicated, treated at 28 wks gestation; this did not work because mothers frequently became re-colonized by time of delivery. B. Screening Infants: Current recommendations: Obtain a CBC and blood culture. Former recommendations: Obtain urine for GBS Antigen, LP, gastric aspirate for GBS, surface cultures for GBS, latex agglutination tests on CSF blood and urine. None of these tests had any predictive value. Prevention of GBS Disease in Colonized Mothers: Current recommendations: 2 different recommendations: Give Intrapartum antibiotic prophylaxis (IAP) either to all colonized mothers regardless of risk factors (AAP recommendation) or to all mothers with risk factors, such as previous infant with invasive GBS disease, GBS bacteruria during pregnancy, delivery at less than 37 weeks gestation, ruptured membranes >18 hours, maternal temp >38.0 C regardless of GBS status (ACOG) Former recommendations: Immunize moms against GBS, give mothers IVIG or hyperimmune anti-GBS IVIG, treat infants born to GBS + moms with penicillin after birth and give infants IVIG. What is Considered Adequate IAP? AAP- 2 doses of IV penicillin, given 4 hours apart, prior to delivery; CDC- at least one dose of IV penicillin, given 4 hours prior to delivery. Evaluation of the Newborn born to a GBS + mother or if GBS status unknown: Asymptomatic term newborns (> 35 wks EGA): if mother received adequate treatment- no evaluation, no treatment, observe 48 hours; if mother not adequately treated, get a CBC, blood culture, and observe 48 hours. Asymptomatic preterm infants (< 35 wks EGA)- regardless of IAP- CBC, blood cx, observe 48 hours. Symptomatic newborns- full diagnostic evaluation including CBC, blood culture, LP, and CXR if respiratory symptoms are present. Treatment: Antibiotic therapy- ampicillin and gentamicin x 48-72 hrs, D/C antibiotics if lab and clinical course don’t suggest sepsis; if any findings suggest sepsis tx for 7-10 days; if meningitis tx for 14 days. |
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© Medical College of Georgia |
Department of Pediatrics |
Medical College of Georgia February 27, 2004 |