Group B streptococcal infection laboratory tests
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Differentiating Group B Streptococcal Infection from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Laboratory Tests
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 the maternal colonization status (class A, level of evidence II).
The full diagnostic evaluation should include:
- CBC including white blood cell differential and platelet count
- Blood culture (Blood cultures can be sterile in as many as 15%--33% of newborns with meningitis)
- Chest radiograph
- Lumbar puncture
- Culture of the cerebrospinal fluid (CSF)
Infants Born to Women with Chorioamnionitis
Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited diagnostic evaluation and receive antibiotic therapy pending culture results (class A, level of evidence II).
The limited diagnostic evaluation should include:
- CBC including white blood cell differential and platelet count
- Blood culture
- No chest radiograph
- No lumbar puncture
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.
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).