GBS Flow Sheet: Management of Infants ≥35 wks on postnatal ward with risk factors for Early Onset Sepsis (June 2019) Is the infant SYMPTOMATIC?
Tachypnoea (RR>60) Apnoea and/or cyanosis Hypotension (Mean BP < Gestational Age) Temperature instability (temp < 36.5 or > 37 .5°C) Tachycardia > 180 bpm Oxygen saturation < 95% And/Or Any other medical concerns
ADMIT to NICU/SCBU
YES
Full Sepsis evaluation as clinically indicated If sepsis suspected, empiric TREATMENT Yes antibiotic therapy is indicated
NO Did a previous sibling or did the mother have laboratory confirmed GBS sepsis or meningitis
YES
Neonatal review Limited Sepsis evaluation Empiric PROPHYLACTIC antibiotic therapy
Yes
NO Neonatal review AND Apply “EOS Calculator” using highest ANTENATAL maternal temperature
Was there evidence of:
Maternal pyrexia in labour (≥38⁰C in labour or within 4 hours of delivery)
Clinical suspicion of chorioamnionitis raised by Obstetric staff
Mother received a dose of broad spectrum antibiotics or triple antibiotics (benzylpenicillin, gentamicin and flagyl) for chorioamnionitis
2 possible options:
YES
No
Observations every 6 hrs x 24 hrs and again at 36 hrs OR
Limited Sepsis Evaluation and empiric PROPHYLACTIC antibiotic therapy
Neonatal review AND Apply “EOS Calculator”
NO
2 possible options:
YES
Was there PROM > 72 hours
Observations every 6 hrs x 24 hrs and again at 36 hrs OR
Limited Sepsis Evaluation and empiric PROPHYLACTIC antibiotic therapy
NO Has the baby all 3 risk factors:
Neonatal review AND Apply “EOS Calculator”
35-37 wks gestation AND
PROM ≥18 hours AND
Mother is GBS positive or GBS status unknown
YES
2 possible options:
Observations every 6 hrs x 24 hrs and again at 36 hrs OR
Limited Sepsis Evaluation and empiric PROPHYLACTIC antibiotic therapy
NO If the mother received < 2 doses of intrapartum antibiotics → infant to be monitored on PNW. Minimum Obs every 6 hrs x 24 hrs and again at 36 hrs All other infants with any risk factor(s) for sepsis not covered by in the above categories
[Type text]
If the mother received ≥ 2 doses of intrapartum antibiotics, then routine neonatal care as per local unit guidelines is advised. These babies should stay in hospital for a minimum of 12 hrs postnatally.