Legal Briefs: Late-Onset Group B Streptococcus Meningitis: Should It Happen in a Newborn Intensive Care Unit?

Abstract

* Abbreviations: BP; : blood pressure CBC; : complete blood cell CNS; : central nervous system EOGBS; : early-onset group B Streptococcus GBS; : group B Streptococcus HR; : heart rate IAP; : intrapartum antibiotic prophylaxis ID; : infectious disease LOGBS; : late-onset group B Streptococcus A 28-6/7-weeks'-gestational-age boy whose birthweight was 1,340 g was born to a 32-year-old G3P0 woman whose pregnancy was complicated by a short cervix and preterm labor. Two cervical cultures and 1 urine culture were positive for group B Streptococcus (GBS), the latest positive cervical culture taken 2 days before delivery. Antibiotics were not given despite preterm labor with a positive GBS culture and bacteriuria. The infectious disease (ID) consult retained by the plaintiff was critical of this omission. The mother was given magnesium sulfate for tocolysis and antenatal steroids. An emergency cesarean delivery was performed because of heart rate (HR) decelerations down to the 70s for 6 to 7 minutes. At the time of delivery, membranes were ruptured and clear fluid was found. Apgar scores were 91 and 105. The GBS status was documented “unknown” in the delivery and neonatal records and remained unknown throughout the infant’s hospital stay. The plaintiff ID expert was critical of the physicians caring for the infant because he felt they should have become aware of the maternal GBS status . The treating neonatologists pointed out that nothing would have been done differently for the infant with that knowledge because the infant ’ s blood culture was sent and he was given empiric antibiotic. Continuous positive airway pressure was started immediately after birth, but because respiratory distress syndrome developed, he was intubated and given poractant alfa (Curosurf; Cornerstone Therapeutics, Inc, Cary, NC). The infant was extubated a few hours later and remained on room air for 1 month, initially with nasal continuous positive airway pressure, then nasal cannula. The blood culture was negative, and complete blood cell (CBC) count was normal. Ampicillin and gentamicin were discontinued after 2 days. His baseline HRs averaged 146 beats per minute until caffeine was started. Then …