With any policy that involves treating some women with antibiotics following the start of labour to prevent GBS infection, a strategy for the subsequent management of the newborn baby required. Below is GBSS’s recommended paediatric prevention strategy against early-onset GBS infection: Signs of possible infection in baby or mother
YES
Baby examined thoroughly by a paediatrician
•
Sepsis work up
•
Intravenous antimicrobial therapy
•
Baby examined thoroughly by a paediatrician
• •
Sepsis work up Intravenous antimicrobial therapy UNLESS a robust examination determines Baby is completely healthy
•
Baby examined and investigated by a paediatrician as appropriate Observed for a minimum of 12 (ideally 24) hours If completely healthy, no antibiotics for Baby are required (antibiotics should be administered if there is any doubt)
No
•
Baby’s gestational age less than or equal to 35 completed weeks of pregnancy AND baby born by Caesarean section (not in labour, no broken waters)
YES
No
One or more risk factor present AND duration of intravenous antibiotics given to Mum in labour before delivery LESS THAN two hours
YES
• •
No
One or more risk factor present AND duration of intravenous antibiotics given to Mum in labour before delivery AT LEAST two hours AND no signs of infection
•
YES
• •
•
If there’s any doubt about whether an infection is present, Baby should be started on intravenous antibiotics until it is known that he/she is not infected
Baby sepsis work up tests: Essential: - Full Blood Count (FBC) and differential; - C Reactive Protein (CRP) – 2 tests, 12-24 hours apart; - Blood Culture; and - Deep Ear Swab
Baby carefully assessed by an appropriately trained Paediatrician or Advanced Neonatal Nurse Practitioner If completely healthy, no antibiotics for Baby are required A period of monitoring (12-24 hours) may be appropriate for those at highest risk of infection Parents should be made aware of the early signs of infection and given a handout on GBS
Most common risk factors: • Prematurity (≤36 weeks of pregnancy) • PROM > 18 hours • Maternal GBS colonisation
Optional (depending on clinical indication): - Chest X-Ray - Lumbar Puncture - Gastric Aspirate - Antigen Test