Also, well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation (blood culture and CBC as above, but no chest x-ray or lumbar puncture is necessary) and should receive antibiotic treatment pending culture results. Well-appearing infants whose mothers had no chorioamnionitis and no indication for GBS prophylaxis should be managed according to routine clinical care.
Other key components of the algorithm call for the following:
▸ Observation for at least 48 hours – but no routine diagnostic testing – in well-appearing infants of any gestational age whose mother received adequate intrapartum GBS prophylaxis (clarified in the newly revised guidelines to be at least 4 hours of intravenous penicillin, ampicillin, or cefazolin before delivery). Observation now is also recommended in well-appearing infants born to mothers who had an indication for GBS prophylaxis but received no or inadequate prophylaxis, as long as the infant is at least 37 weeks' gestational age, and the duration of membrane rupture before delivery was less than 18 hours.
▸ Limited evaluation and observation for at least 48 hours in well-appearing infants born to mothers with an indication for prophylaxis, but who received no or inadequate prophylaxis, when the infant is less than 37 weeks' gestation or duration of membrane rupture before delivery was 18 hours or more.
Well-appearing infants with a gestational age of 35–36 weeks whose mothers received adequate intrapartum antibiotic prophylaxis do not routinely require diagnostic evaluations.
In addition to these steps, research aimed at better understanding the racial and ethnic differences that still persist in GBS disease incidence is needed, according to the CDC report. Research is needed on strategies for preventing early-onset disease among preterm infants, the role of bacteriuria as a risk factor, effectiveness of the recommended intrapartum antibiotic prophylaxis agents for penicillin-allergic women at high risk for anaphylaxis, the impact and effectiveness of recommendations for secondary prevention of early-onset disease among neonates, and factors contributing to the higher than anticipated proportion of early-onset GBS disease cases occurring among infants born to women with negative prenatal GBS screens. Such ongoing research is important because, in the absence of a licensed GBS vaccine, universal screening and intrapartum antibiotic prophylaxis continue to be the cornerstones of prevention, the report states.
“I'm very optimistic that there will be high compliance both on the baby side and the mother's side,” Dr. Carol Baker said.
Source Courtesy Marcia A. Rench