Newborn GBS Screening and Treatment

Suggested Management Algorithm:
 
 
Intrapartum penicillin should have been administered under any of the following conditions 
  • Positive risk factors
    • Previous infant with GBS disease (regardless of current culture status)
    • GBS bactiuria at any time during the present pregnancy
    • Delivery at less than 37 weeks GA (unless negative Cx at 35-37 wks)
  • Positive GBS rectal or vaginal Cx at 35-37 weeks
  • Culture results unknown, incomplete, or not done AND either
    • Intrapartum temperature greater than 38oC (100.4oF).

      • Greater than 18 hours ROM
Any child who appears septic or in whom sepsis is suspected should be treated with a full diagnostic evaluation (including CBC and differential count, blood culture.  If respiratory symptoms, a chest x-ray.  Lumbar puncture at the discretion of managing physician) and empiric therapy, usually ampicillin and gentamycin.  The duration of this therapy will be based on laboratory results and clinical status.

Any child born at less than 35 wks GA, or any child whose mother had the above risk factors yet received less than 2 doses of penicillin or ampicillin chemoprophylaxis should have a limited evaluation (CBC and blood culture) and should be observed for 48 hours.

Children born to a mothers who received adequate chemoprophylaxis (2 or more doses of penicillin or ampicillin) prior to delivery, who are more than 35 wk GA, and who look good clinically should still be monitored for 48 hours, but do not require diagnostic testing or treatment unless their clinical condition suggests it.
 
based on the AAP Guideslines appearing in Pediatrics 99(3):489-496.

see also: Guidelines for Intrapartum GBS Chemoprophylaxis
 
Neonatology 
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Last modification: July 8, 1999