Term
| What pregnant mom's should be screened for GBS colonization during pregnancy? |
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Definition
| All of them at 35-37 weeks gestation unless they have had a GBS UTI during the pregnancy (implies heavy colonization) or a prior infant with GBS sepsis. |
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Term
| What is a "GBS positive" mom? |
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Definition
Three possible things:
1)GBS positive screening cx at 35-37 weeks EGA
2) Positive urine culture for GBS at any point during the pregnancy
3)Prior infant with GBS sepsis
note: previous pregancy maternal GBS colonization doesn't count... only prior infant with GBS sepsis
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Term
| What is "adequate" intrapartum prophylaxis for GBS positive moms? |
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Definition
| IV antibiotics (usually Ampicillin), receiving at least one dose, at least 4 hours prior to delivery |
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Term
| A 38 week EGA infant is born to a GBS positive mom. The labor was unremarkable and the mom received IV Ampicillin 6 hours prior to delivery. How should you manage the infant? |
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Definition
| Observation and workup only if symptoms suggestive of sepsis develop. |
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Term
| A 37 week infant is born to a GBS positive mom who received 1 dose of IV Ampicillin 2 hours before delivery. The infant is well appearing. How should you manage this infant? |
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Definition
| Obtain screening CBC and blood culture, observe for signs of sepsis, begin antibiotics if CBC abnormal or signs of sepsis develop. |
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Term
| What is a "normal screening CBC" for a newborn |
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Definition
In general it is:
WBC 9-34k
plts >150
I/T ratio <.20 |
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Term
| A mom in labor reports her previous infant had GBS meningitis in the nursery. How should you manage this mom and infant? |
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Definition
| As if the mom were GBS positive. (intrapartum Ampicillin) Screening of infant only if intrapartum prophylaxis is inadequate. |
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Term
A mom show up in labor and delivery and her
GBS status is unknown. How should she be managed in labor? How should the baby be managed? |
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Definition
The mom: Intrapartum prophylaxis is recommended if :
EGA <37 weeks
Maternal temp>100.4
Rupture of Membranes >18 hours
Screening of the baby is a bit more controversial:
At St. Vincent's the neonatologists and community pediatricians screen these babies with CBC and blood culture unless the mom received prophylaxis at least 4 hours before delivery. That is what I would recommend as well. |
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Term
| A 39 week EGA infant is born to a GBS positive mom who received intrapartum prophylaxis 2 hours before delivery. The infant is born lethargic with poor tone, tachypnea and grunting. How should you manage this baby? |
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Definition
Sepsis work up to include CBC, Blood culture, CXR, (LP if stable enough to tolerate) and empiric Amp/Gent. This baby will require transfer to the special care nursery.
Note: Any infant with these symptoms, regardless of maternal GBS status, would deserve the same |
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Term
| What is the difference between "early onset" and "late onset" GBS disease? |
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Definition
Early onset is <7days
Late onset is 8 days - approx 3 months |
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Term
| Does GBS screening and intrapartum prophylaxis help prevent early onset disease, late onset disease or both? |
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Definition
ONLY early onset disease.
We make it a point to counsel all babies to call if they develop fever >100.4, lethargy, poor feeding, irritability or breathing issues in the first 2-3 months of life.
Be sure that you don't forget to do this counseling in GBS positive situations. |
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Term
| An infant is born at 35 weeks gestation to a GBS positive mom who received IV Ampicillin 5 hours before delivery. How should you manage this infant? |
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Definition
Screening CBC and blood culture.
Even with adequate intrapartum prophylaxis, infants <35 weeks gestation should be screened. |
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