Management of the infant whose mother has received group B streptococcal chemoprophylaxis
- Karen M Puopolo, MD, PhD
Karen M Puopolo, MD, PhD
- Associate Professor of Clinical Pediatrics
- University of Pennsylvania Perelman School of Medicine
- Carol J Baker, MD
Carol J Baker, MD
- Professor of Pediatrics, Molecular Virology and Microbiology
- Baylor College of Medicine
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Group B streptococcus (GBS or Streptococcus agalactiae) is an encapsulated gram-positive bacterium that colonizes the human gastrointestinal and genital tracts. GBS is the most frequent bacterial pathogen in neonates, and maternal colonization is the single most important risk factor for early-onset (younger than seven days of age) GBS infection [1,2]. Screening pregnant women for GBS colonization and administering intrapartum antibiotic prophylaxis (IAP) against GBS is the recommended approach to the prevention of early-onset infection in neonates [3,4]. However, this approach does not prevent all cases of early-onset GBS disease and does not prevent late-onset GBS disease (see "Neonatal group B streptococcal disease: Prevention"). Rapid detection and early initiation of appropriate antimicrobial therapy is necessary to minimize morbidity and mortality among the cases that continue to occur.
The evaluation and initial management of neonates at risk for early-onset GBS is reviewed here. Chemoprophylaxis of the mother, established GBS infection in infants and pregnant women, the microbiology and epidemiology of GBS, and the status of GBS vaccines are discussed separately. (See "Neonatal group B streptococcal disease: Prevention" and "Group B streptococcal infection in pregnant women" and "Group B streptococcal infection in neonates and young infants" and "Group B streptococcus: Virulence factors and pathogenic mechanisms" and "Vaccines for the prevention of group B streptococcal disease".)
SUMMARY OF MATERNAL IAP GUIDELINES
The Centers for Disease Control and Prevention (CDC) in collaboration with the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Nurse-Midwives, and the American Society for Microbiology issued new guidelines for the prevention of perinatal group B streptococcal (GBS) disease in 2010 [4,5]. Guidelines for maternal screening and administration of intrapartum antibiotic prophylaxis (IAP) are discussed separately (see "Neonatal group B streptococcal disease: Prevention"). Aspects of maternal IAP that affect newborn management are summarized below.
Indications for maternal IAP — The CDC guidelines recommend that all pregnant women be screened for GBS colonization with swabs of the lower (introitus) vagina and rectum at 35 to 37 weeks of gestation .
IAP should be administered to (table 1):
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- Committee on Infectious Diseases, Committee on Fetus and Newborn, Baker CJ, et al. Policy statement—Recommendations for the prevention of perinatal group B streptococcal (GBS) disease. Pediatrics 2011; 128:611.
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- Stoll BJ, Hansen N, Fanaroff AA, et al. To tap or not to tap: high likelihood of meningitis without sepsis among very low birth weight infants. Pediatrics 2004; 113:1181.
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- Newman TB, Puopolo KM, Wi S, et al. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics 2010; 126:903.
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- Puopolo KM, Eichenwald EC. No change in the incidence of ampicillin-resistant, neonatal, early-onset sepsis over 18 years. Pediatrics 2010; 125:e1031.
- Escobar GJ, Puopolo KM, Wi S, et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics 2014; 133:30.
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- SUMMARY OF MATERNAL IAP GUIDELINES
- Indications for maternal IAP
- Adequate IAP
- OVERVIEW OF MANAGEMENT
- Diagnostic evaluation
- - Full evaluation
- - Limited evaluation
- - Interpretation
- Empirical antibiotic therapy
- MANAGEMENT APPROACH
- Ill-appearing infant
- Well-appearing infants
- - Maternal chorioamnionitis
- - Mother received adequate IAP
- - Mother received no or inadequate IAP
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS