Group B streptococcal infection laboratory tests
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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
Shown below is a tables that summarizes the laboratory tests that are recommended in different scenarios of possible GBS infection in neonates.
| Scenario | Recommended Diagnostic Evaluation |
| Infants with signs of sepsis | Complete diagnostic evaluation
|
| Infants born to women with chorioamnionitis | Limited diagnostic evaluation
|
| Well-appearing infants PLUS The mother had no chorioamnionitis and no indication for GBS prophylaxis |
No routine diagnostic testing |
| Well-appearing infants PLUS The mother received adequate intrapartum GBS prophylaxis |
No routine diagnostic testing |
| Well-appearing infants PLUS The mother had an indication for GBS prophylaxis but received no or inadequate prophylaxis PLUS The infant is well-appearing PLUS ≥37 weeks and 0 days' gestational age PLUS The duration of membrane rupture before delivery was <18 hours |
No routine diagnostic testing |
| Well-appearing infant PLUS Either <37 weeks and 0 days' gestational age OR The duration of membrane rupture before delivery was ≥18 hours |
Limited diagnostic evaluation
|
GBS Infection in Neonates
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, and no routine diagnostic testing is recommended.
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 (class B, level of evidence III).
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 (class B, level of evidence III).
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 diagnostic evaluation and observation for ≥48 hours (class B, level of evidence III).
The limited diagnostic evaluation should include:
- CBC including white blood cell differential and platelet count
- Blood culture
- No chest radiograph
- No lumbar puncture