Unnecessary Workup of Asymptomatic Neonates in the Era of Group B Streptococcus Prophylaxis

Brad Buckler,William Cagle,Ralph Sams,Sue Anne Bell,Don Sutherland,Jatinder Bhatia,Jason Bell,Carla Allen

doi:10.1155/2010/369654

Abstract

Asymptomatic term neonates born to mothers who are Group B Streptococcus (GBS) unknown or GBS positive but “inadequately” treated prior to delivery do not require invasive laboratory evaluation. We conducted a retrospective cohort study of mother/baby dyads born from January 1, 2005 until September 30, 2007 at the Medical College of Georgia. Their current protocol is to obtain a Complete Blood Count with Differential (CBC with D), Blood Culture (BC), and C-reactive protein (CRP) after birth. Mother/baby dyads (n = 242) that met inclusion criteria were reviewed. Of these 242 babies 25 (10%) were started on antibiotics after the initial lab values were known. None of the blood cultures were positive and the CRP's were normal. The 2002 GBS guidelines call for laboratory evaluation of “at-risk” neonates, but the workup of these babies is not only costly, it does not provide any advantage over old fashioned clinical observation for the evaluation and treatment of early onset GBS sepsis.

Highlights

Group B Streptococcus (GBS) is a gram-positive cocci that may be found in the gastrointestinal tract, respiratory tract, urinary tract, and genital tract [1]
Asymptomatic term neonates born to mothers who are GBS unknown or GBS positive but “inadequately” treated prior to delivery do not require invasive laboratory evaluation [1, 3]
Antibiotic therapy was discontinued after 48 hours on 23 out of the 25 babies that were started on antibiotics, and the other 2 babies received 7 days of antibiotics for signs of clinical sepsis

Summary

Introduction

Group B Streptococcus (GBS) is a gram-positive cocci that may be found in the gastrointestinal tract, respiratory tract, urinary tract, and genital tract [1] It is one of the most common causes of early onset neonatal sepsis, which occurs within the first 6 days of life. Asymptomatic term neonates born to mothers who are GBS unknown or GBS positive but “inadequately” treated prior to delivery do not require invasive laboratory evaluation [1, 3]. This evaluation may include a Complete Blood Count with Differential (CBC with D), a Blood Culture (BC), and a C-reactive protein (CRP). The Center for Disease Control (CDC) 2002 GBS guidelines call for a laboratory evaluation of “at risk” neonates, but they do not provide data to the usefulness of this practice [4]

Methods

Results

Discussion

Conclusion