Early Onset Sepsis: GBS

GBS GBS remains leading cause of serious neonatal infection in US. Majority of infections occur within first week of life. Usually presents with pneumonia or sepsis; less often meningitis, osteomyelitis, etc.

GBS (cont.) Approximately 10-30% of women are colonized with GBS in vagina or rectum. Colonization may be transient, chronic or intermittent. GBS colonization is a major risk factor for early onset disease in newborn.

Chorioamnionitis Maternal chorioamnionitis is a major risk factor for neonatal sepsis. Evaluation and treatment of the infant born to a mother with chorio, or the infant with clinical signs of sepsis, is not dependent on the mother’s GBS status.

GBS Prophylaxis Women who have GBS bacteruria at any time are presumed heavily colonized, and should receive intrapartum antibiotic prophylaxis. Women who have previously given birth to infant with invasive disease should also receive intrapartum antibiotics. GBS women who have C/S before ROM and onset of labor, do not routinely require antibiotic prophylaxis. GBS unknown at onset of labor and < 37 weeks gestation, PROM > 18hrs, temp > 100.4, positive rapid GBS screen should receive antibiotic prophylaxis. Only treatment with penicillin, ampicillin and Cefazolin are considered adequate intrapartum prophylaxis, and should be received > 4 hrs prior to delivery.

Maternal signs of Chorioamnionitis Maternal fever > 102 degrees F OR Fever > 100.4 degrees F with either foul smelling amniotic fluid or uterine tenderness Grey area: Fever > 100.4 but < 102 F with no localizing signs, and OB cannot r/o chorioamnionitis.

Symptomatic Infant In all symptomatic infants, a sepsis screen should be done and the infant should be started on broad-spectrum antibiotics. Abnormal CBC : WBC < 5000 or > 30,000; bands > 20%; platelets < 100,000. Sensitivity of CBC lowest immediately after birth, but improved by 4-6 hours of life.

Signs of Sepsis Poor perfusion Grunting, flaring, retractions Apnea Lethargy Temperature instability

Early Onset Sepsis Algorithm

CDC Guidelines CDC Recommended Management: 2002 vs 2010