Group B streptococcal infection laboratory tests: Difference between revisions
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===Infants Born to Women with Chorioamnionitis=== | ===Infants Born to Women with Chorioamnionitis=== | ||
Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation and receive antibiotic therapy pending culture results (AII). The evaluation should include a blood culture and a CBC including white blood cell differential and platelet count; no chest radiograph or lumbar puncture is needed. Consultation with obstetric providers to assess whether chorioamnionitis was suspected is important to determine neonatal management (CIII). | Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation and receive antibiotic therapy pending culture results (AII). The evaluation should include a blood culture and a CBC including white blood cell differential and platelet count; no chest radiograph or lumbar puncture is needed. Consultation with obstetric providers to assess whether chorioamnionitis was suspected is important to determine neonatal management (CIII). | ||
===Well-Appearing Infants Exposed to Inadequate Intrapartum Antibiotics=== | |||
Well-appearing infants whose mothers had no [[chorioamnionitis]] and no indication for GBS prophylaxis should be managed according to routine clinical care (CIII). | |||
Well-appearing infants of any gestational age whose mother received adequate intrapartum GBS prophylaxis (≥4 hours of [[penicillin]], [[ampicillin]], or [[cefazolin]] before delivery) should be observed for ≥48 hours, and no routine diagnostic testing is recommended (BIII). Such infants can be discharged home as early as 24 hours after delivery, assuming that other discharge criteria have been met, ready access to medical care exists, and that a person able to comply fully with instructions for home observation will be present (CIII). | |||
For well-appearing infants born to mothers who had an indication for GBS prophylaxis but received no or inadequate prophylaxis, if the infant is well-appearing and ≥37 weeks and 0 days' gestational age and the duration of membrane rupture before delivery was <18 hours, then the infant should be observed for ≥48 hours, and no routine diagnostic testing is recommended (BIII). If the infant is well-appearing and either <37 weeks and 0 days' gestational age or the duration of membrane rupture before delivery was ≥18 hours, then the infant should undergo a limited evaluation and observation for ≥48 hours (BIII). | |||
==References== | ==References== | ||
Revision as of 16:11, 19 August 2014
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Group B Streptococcal Infection Microchapters |
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Differentiating Group B Streptococcal Infection from other Diseases |
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Group B streptococcal infection laboratory tests On the Web |
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Directions to Hospitals Treating Group B streptococcal infection |
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Risk calculators and risk factors for Group B streptococcal infection laboratory tests |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Laboratory Findings
Infants with Signs of Sepsis
Any newborn with signs of sepsis should receive a full diagnostic evaluation and receive antibiotic therapy pending the results of the evaluation, regardless of maternal colonization status. The evaluation should include a blood culture; a CBC including white blood cell differential and platelet count; a chest radiograph if any abnormal respiratory signs are present; and a lumbar puncture if the newborn is stable enough to tolerate the procedure and sepsis is suspected. Therapy for the infant should include antimicrobial agents active against GBS (including intravenous ampicillin) as well as other organisms that might cause neonatal sepsis, such as E. coli (AII).
Among infants with signs of early-onset disease, the detection of GBS can be increased by performing culture of both blood and cerebrospinal fluid (CSF). Blood cultures can be sterile in as many as 15%--33% of newborns with meningitis, and the clinical management of an infant with abnormal CSF findings differs from that of an infant with normal CSF.
Infants Born to Women with Chorioamnionitis
Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation and receive antibiotic therapy pending culture results (AII). The evaluation should include a blood culture and a CBC including white blood cell differential and platelet count; no chest radiograph or lumbar puncture is needed. Consultation with obstetric providers to assess whether chorioamnionitis was suspected is important to determine neonatal management (CIII).
Well-Appearing Infants Exposed to Inadequate Intrapartum Antibiotics
Well-appearing infants whose mothers had no chorioamnionitis and no indication for GBS prophylaxis should be managed according to routine clinical care (CIII).
Well-appearing infants of any gestational age whose mother received adequate intrapartum GBS prophylaxis (≥4 hours of penicillin, ampicillin, or cefazolin before delivery) should be observed for ≥48 hours, and no routine diagnostic testing is recommended (BIII). Such infants can be discharged home as early as 24 hours after delivery, assuming that other discharge criteria have been met, ready access to medical care exists, and that a person able to comply fully with instructions for home observation will be present (CIII).
For well-appearing infants born to mothers who had an indication for GBS prophylaxis but received no or inadequate prophylaxis, if the infant is well-appearing and ≥37 weeks and 0 days' gestational age and the duration of membrane rupture before delivery was <18 hours, then the infant should be observed for ≥48 hours, and no routine diagnostic testing is recommended (BIII). If the infant is well-appearing and either <37 weeks and 0 days' gestational age or the duration of membrane rupture before delivery was ≥18 hours, then the infant should undergo a limited evaluation and observation for ≥48 hours (BIII).