GTG Flashcards
What is the organism responsible for most cases of late - onset neonatal sepsis ( > 7 days)?
E coli
What is the organism responsible for early onset neonatal sepsis ( > 7 days)?
Group B streptococcus
What is the definition of early onset neonatal sepsis?
Neonatal sepsis takes place;
< 72h in infants hospitalized in NICU
< 7 days in term infants
What is the percentage of neonatal infection developing within 48h of birth caused by GBS?
50 %
What is the percentage of GBS carriers in UK ( colonization) ?
25 %
20 - 40 %
if GBS detected in previous pregnancy ,what is the percentage of GBS carriage in this pregnancy?
50 %
When to do bacteriological testing for GBS if indicated?
35 - 37 w
OR 3 - 5 w before EDD
Ex: 32 - 34 w for women with twins
MCDA : 31 - 33 w
DCDA : 32 - 34 w
Is maternal request an indication for test carrier GBS status?
Not indication for bacterial screening
Why routine antenatal GBS screening is NOT recommended in UK ?
1- 25 % of GBS positive swab will be negative at delivery
2- 7 % who are GBS negative swab will be positive at delivery
3- many babies severely affected by GBS are born premature
What is the screening method for GBS carriage?
Lower vaginal + rectal
Rectal swabs: improves sensitivity 22 👉 27 % ( 5 % )
What is the drug treatment for GBS prophylaxis
🚩Drug of choice: benzyl penicillin
3 g after onset of labour then
1,5 g / 4 h until delivery
🚩known or suspected penicillin allergy: Cephalosporin
🚩any evidence of SEVERE allergy:
Vancomycin 1g /12h
If the patient develops any symptoms during GBS prophylaxis with penicillin (Vomiting / urticaria, RDS,angioedema ),how to manage?
Vomiting Only 👉 continue penicillin
Severe anaphylaxis 👉 Vancomycin
1 g / 12 h
Mild or suspected anaphylaxis 👉
Cefuroxime 1,5 g then 750g/8h
If GBS carriage detected antenatally in vaginal discharge or urine,
-When to treat antenatally?
-When to give intrapartum antibiotics prophylaxis IAP?
🚩Vaginal: Just IAP
Antenatal treatment NOT
recommended
🚩 urine: IAP
GBS < 10⁵ 👉 NO antenatal
treatment
GBS > 10⁵ 👉 antenatal
treatment recommended
If the patient is a GBS carrier in previous pregnancy, what is the management?
Options:
1- IAP or
2- testing 3 - 5 w before EDD or
3- BETTER : No action done
What is the management in each case;
* current pregnancy GBS bacteuria
* current pregnancy GBS vaginal
discharge
*previous baby with sepsis ( late / early)
* previous baby with sepsis swab negative for GBS
🚩 current pregnancy GBS bacteuria
👉 treat now + IAP
🚩 current pregnancy GBS vaginal
discharge 👉 IAP
🚩previous baby with sepsis ( late / early)👉 IAP
🚩 previous baby with sepsis swab negative for GBS 👉 IAP
What is the management:
GBS colonization + IUFD ?
No IAP
What is the management;
GBS colonization + CS before the onset of labour or rupture of membranes?
No IAP
What is the management:
GBS carrier + delivery by CS after spontaneous rupture of membranes?
IAP + category 2 or 3 CS
Should being a GBS carrier influence the method of induction labour?
Should not vary according to GBS status
Is being a GBS carrier a contraindication to membran sweeping?
Membran sweeping is not contraindicated in women who are GBS carrier
What is the management:
Rupture of membranes at term + unknown GBS status?
Induction of labour immediately OR
Expectant management up to 24h
Beyond 24h induction of labour is appropriate
Rupture of membranes at term + known GBS carrier?
IAP + induction of labour
Pyrexia ( 38 / 100,4) in labour + unknown GBS status?
Broad spectrum antibiotics
Amoxicillin 2g / 6h
Or : cephuroxim 1,5 g /6h
Preterm labour + unknown GBS status?
IAP
Preterm planned CS without labour + unknown GBS status?
NOT RECOMMENDED IAP
Is there a role for PCR or other near patient testing at the onset of labour in GBS carriers?
Not recommended
Can GBS positive women have water birth?
Not contraindicated
Preterm prelabour rupture of membranes < 37 + unknown GBS status?
IAP should be given once labour is confirmed or induced
Preterm prelabour rupture of membranes + GBS positive?
- <34
- 34-37
34 -37 w 👉 IAP + expedite delivery
< 34 w 👉 expectant management
How should known GBS colonization women who decline IAP be managed?
Monitor the neonate very closely for 12 h after birth
What are the adverse effects of IAP?
1- maternal anaphylaxis
2- altered neonatal bowel flora
3- abnormal child development
Should vaginal cleansing be performed in labour in GBS carriers?
No evidence that intrapartum vaginal cleansing will reduce the risk of neonatal GBS
If there have been any concerns about early onset neonatal infection, what signs should prompt parents to seek medical advice?
1- abnormal behavior
2- unusually floppy
3- difficulties with feeding
4 - abnormal temperature ( <36/ > 38)
5- rapid breathing
6- change in skin color
How should term babies whose mothers have adequate IAP be managed?
Treat as normal
Don’t require special observation
What is the meaning of adequate IAP ?
First dose of IAP more than 4 hours before delivery
Minimum 2 hours
How should well babies at risk of EOGBS disease whose mothers have Not received adequate IAP be monitored?
Increased observation for 12 h
1- At birth for clinical indicators of infection
2- vital signs: 0 ,1 ,2 hours then every 2 hours until 12 h
When postnatal antibiotics prophylaxis is not recommended?
Low risk - asymptomatic- term babies
How should a baby with clinical signs of EOGBS disease be managed?
Should be treated with
Penicillin + gentamicin within an hour of decision to treat
How should the baby of a mother who has a previous baby with GBS disease be managed?
Increased observation
1-at birth for clinical indicators of infection
2- vital signs checked 0 ,1 ,2 h and then every 2 hours until 12 hours
What advice should be given to women regarding breastfeeding in case of GBS carriage?
Breastfeeding should be encouraged
What are the indications for increased neonatal observation in the first 12 hours regarding early detection of EOGBS?
1- the mother is GBS positive & hasn’t had adequate IAP
2- previous baby with EOGBS
3- the mother is GBS positive & declined IAP
What is the prevalence of EOGBS?
O.5 / 1000
If intrapartum pyrexia 5 / 1000
Previous baby with EOGBS 1 / 700
What are the clinical risk factors that affect the risk of GBS disease?
1- having a previous baby with GBS
2- maternal GBS carriage through investigations during pregnancy ( urine, vaginal discharge)
3- preterm birth
4- prolonged rupture of membranes
5- suspected maternal intrapartum infection ( eg: chorioamnionitis)
6- pyrexia in labour 38
Mortality rate from EOGBS
- at term
- preterm
At term 2- 3 %
Preterm 20 - 30 %
What is the recommendations regarding preterm prelabour rupture of membranes about antenatal antibiotics until the labour is established,?
Erythromycin 250 / 4 times daily for maximum 10 days
Alternative: penicillin if erythromycin is contraindicated
Why limiting neonatal observation for EOGBS to 12 hours?
90 % of infants who are diagnosed with EOGBS will display signs by 12 hours
Is IPA has any benefits in reducing the risk of late onset neonatal disease ?
Noo
What proportion of neonatal infection developing within 48h caused by GBS?
50 %
