Group B Streptococcus (GBS) Management

Maternal & Neonatal Risk Factors

• Maternal GBS colonization (rectovaginal screening positive at 36-37 weeks)
• Inadequate Intrapartum Antibiotic Prophylaxis (IAP) (Penicillin/Ampicillin given < 4 hours prior to delivery)
• Preterm birth (< 37 weeks)
• Prolonged rupture of membranes (PROM) > 18 hours
• Maternal intrapartum fever (>38.0°C / 100.4°F) - presumed chorioamnionitis

Clinical Presentation

• Most early-onset GBS disease presents within 24 hours of life
• Respiratory distress, apnea, temperature instability (fever or hypothermia)
• Lethargy, poor feeding, tachycardia

Algorithm & Management

• Infant well-appearing AND Mother received adequate IAP: Routine care, observe for 48 hours
• Infant well-appearing but Mother had presumed chorioamnionitis OR inadequate IAP with PROM >18h: CBC, CRP/PCT, blood culture; close clinical monitoring. Consider empiric antibiotics.
• Infant ill-appearing: Full sepsis workup (CBC, Blood Cxs, consider LP) and START broad-spectrum antibiotics immediately (Ampicillin + Gentamicin)

Infection Control & Pharmacokinetics

• Ampicillin dosing (<7 days, >2kg): 100 mg/kg/dose IV q8h for meningitis coverage; 50mg/kg/dose q12h for bacteremia.
• Gentamicin dosing: 4-5 mg/kg/dose IV q24h; MUST check trough levels prior to 3rd dose (Target trough < 1.0 mcg/mL).
• Strict contact and droplet precautions until specific viral/bacterial pathogen is ruled out.
• Assess for osteomyelitis/septic arthritis with thorough physical exam including joint mobility and symmetry.
• LP execution: Defer lumbar puncture ONLY if infant is hemodynamically unstable or profoundly thrombocytopenic.

Standardized Discharge & Follow-Up Criteria

• Adequate weight gain explicitly > 15-30g/day over a continuous 3-5 day period.
• Maintenance of temperature in an open crib with standard clothing for 48 hours.
• Successful completion of the 90-120 minute Infant Car Seat Challenge.
• Caregiver successfully completed CPR training, rooming-in, and independent medication administration.
• Referrals placed for High-Risk Infant Follow-Up Clinic, Early Intervention (PT/OT), and appropriate sub-specialists.

Diagnostic & Management Algorithm

• GBS Management Algorithm: [START] Maternal GBS+ / Inadequate Prophylaxis -> [DECISION] Infant symptoms? -> [YES] Full Sepsis Workup + Amp/Gent -> [NO] Observe 48 hours

References

1. Puopolo KM, Lynfield R, Cummings JJ. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics.