II. Epidemiology
- Most common US cause of Neonatal Sepsis and Meningitis
-
Incidence
- Overall: 2 to 4 per 1000 live births
- Invasive: 1.8 per 1000 live births
- Primarily occurs in newborns
- Very rare after 5 months of age
III. Risk Factors
- Gestational age <37 weeks
- Maternal GBS colonization isolated from mother's vagina, Rectum or urine
- Inadequate GBS Prophylaxis (if indicated)
- Prolonged Rupture of Membranes >18 hours
- Maternal Chorioamnionitis
- Adair (2003) CMAJ 169(3):198-203 [PubMed]
IV. Pathophysiology
- Group B Beta-Hemolytic Streptococcus infection
- Perinatal transmission
- Delivery via a birth canal colonized with GBS
- Incidence of U.S. vaginal GBS colonization: 15-20%
- Onset of infection (Mean onset 20 hours of life)
- Early onset neonatal disease
- Presentations
- Clinical infection signs in 95% within 24 hours
- Maternal prophylaxis does not delay diagnosis
- Bromberger (2000) Pediatrics 106:244-50 [PubMed]
- Late onset neonatal disease
- Early onset neonatal disease
V. Signs
- See Neonatal Sepsis
VI. Labs
- Newborn
- See Neonatal Sepsis for lab evaluation
- Maternal Screening
- GBS Culture in all pregnant women at 35-37 weeks
VII. Management: Initial
- See Group B Streptococcus Prophylaxis
- Includes guidelines for neonatal evaluation
- See Neonatal Sepsis for initial Antibiotic management
- Convert to Antibiotics below when organism identified
VIII. Management: Group B Streptococcus based on culture
-
Sepsis (treat for 10-14 days)
- Penicillin G 200,000 units/kg/day divided q4-6 hours
-
Meningitis (treat for 14-21 days)
- Penicillin G 400,000 units/kg/day divided q2-4 hours
IX. Prevention
- Perinatal Group B Streptococcus Prophylaxis
X. Prognosis
- Mortality 10-40%