Group B Streptococcus

Question 1

How do infants contract GBS?

Answer 1

vertical transmission

Question 2

Onset of GBS?

Answer 2

early onset= 24 hrs of life

late onset= 7 day - 3 months presents with sepsis or meningitis

Question 3

____ of infants with early onset disease are symptomatic at birth, which could indicate an ______

Answer 3

50%

intrauterine infection

Question 4

The highest rate of infection have what type of delivery?

Answer 4

High risk deliveries such as

• premature infants
• SGA infants
• very low birth weight infants
• infants born to mothers who have had prolonged rupture of membranes

Question 5

What are the clinical findings you might see in an infant with Group B Strep?

Answer 5

infants less than 37 weeks gestation 
ROM of 18+ hours
maternal fever during labor >100.4
previous delivery of a sibling with invasive GBS
Maternal chorioamnionitis including ROM and maternal fever plus 2 of the following:
maternal HR >90 bpm
fetal HR >170 bpm
Maternal WBC >15k 
uterine tenderness
foul smelling amniotic fluid

Question 6

Signs and Symptoms of Neonatal infections

Answer 6

• **Feeding abnormalities~poor feeding, change in feeding behaviors, vomiting, abd. distension
• **Temperature instability ~ hypothermia or hyperthermia
• **Cardiovascular~ tachycardia, bradycardia, hypotension, pallor, weak pulses, decreased urine output
• **Respiratory distress~ cyanosis, apnea, tachypnea, grunting, flaring, use of accessary muscles, retracting
• **Neurological changes ~seizures, lethargy, irritability
• **Jaundice~ progression of jaundice from head to toe, increase in direct or indirect bilirubin
• **Skin changes~ rash, purpura, erythema, pethichiae
• **Metabolic changes~acidosis, hypoglycemia, hypoxia
• ***rapid onset and deterioration

Question 7

GBS diagnostic studies

Answer 7

Required= CSF culture and blood culture
Suggested= CBC/diff. CRP, Urine Culture

Question 8

differential diagnosis for GBS

Answer 8

Respiratory Distress Syndrome
Amniotic fluid aspiration syndrome
persistant fetal circulation 
meningitis
osteomyelitis
septic arthritis
sepsis from other infections
metabolic problems

Question 9

Treatment for GBS

Answer 9

antibiotic therapy with a penicillin and aminoglycoside (often ampicillin and gentamicin) until differentiated from e coli or listeria sepsis or meningitis
ampicillin IV ~
sepsis= ampicillin 50mg /kg/dose IV q 12 hrs
meningitis= ampicillin 100mg/kg/dose IV q12 hrs
Gentamicin IV~
2.5mg/kg/dose IV q 12-24 hrs depending on gestational age

Question 10

GBS prevention ~CDC guidelines

Answer 10

• *screen all pregnant women for GBS @ 35-37 weeks
• *antepartum treatment of asymptomatic GBS positive mothers is not recommended
• *If positive GBS cultures= should receive IV penicillin or ampicillin given at onset of labor, repeated q 4 hrs until the baby is born except in the instance of c section performed before onset of labor on a woman with intact amniotic membranes
• *women with GBS detected in urine or previous child with GBS disease do not need cultures and should automatically get abx during labor

Question 11

GBS more CDC guidelines

Answer 11

laboring women with unknown GBS status should be given antibiotics if labor starts
< 37 weeks
prolonged ROM >18 hrs before delivery
fever during labor
to date, intrapartum IV antibiotics is the only proven method to prevent early onset GBS infections in the newborn
this method does not prevent late stage disease, there has been no identified method to prevent late stage disease
researchers are currently working on a vaccine to prevent GBS infection