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Prevention of Early Onset Neonatal Group B Streptococcal Disease (EOGBS)
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Risk Factors for EOGBS Disease
- Previous baby with GBS disease
- Discovery of maternal GBS carriage through bacteriological investigation during pregnancy: Urine infection or HVS for vaginal discharge
- Preterm delivery
- Prolonged rupture of membranes
- Suspected maternal intrapartum infection, including chorioamnionitis
- Pyrexia in labour
If GBS is detected in a previous pregnancy:
- Likelihood of maternal GBS carriage in this pregnancy = 50%
- Risk of EOGBS disease = 2-2.5 times higher
- Risk of EOGBS disease in the baby = 1 in 700-800
- Risk of EOGBS if positive test: 1 in 400
- Risk of EOGBS if negative test: 1 in 5000
Discuss option of IAP or testing at 35-37 weeks and IAP if still positive
GBS Intrapartum Antibiotic Prophylaxis First-line for IAP: Benzylpenicillin (Penicillin G)
- IV 3g stat dose (should be given at least 4 hours prior to delivery to optimise efficacy)
- IV 1.5g 4 hourly until delivery
Penicillin allergy
- Mild allergy: Cephalosporin (IV Cefuroxime 1.5g stat dose followed by 750mg 8 hourly)
- Severe: IV Vancomycin 1g 12 hourly
(Anaphylaxis, angioedema, respiratory distress, urticaria)
- Clindamycin no longer recommended as resistance rate 16%
Clinical Indicators of Possible EOGBS
- Altered behaviour or responsiveness: Inconsolable crying or listlessness
- Altered muscle tone: Unusually floppy
- Feeding difficulties: Refusing feeds
- Feeding intolerance: Vomiting, excessive gastric aspirates, abdominal distension
- Abnormal heart rate (bradycardia/tachycardia)
- Signs of respiratory distress or respiratory distress >4 hours after birth
- Abnormal temperature (<36 or >38)
- Jaundice within 24 hours of birth
- Signs of neonatal encephalopathy or seizures
- Hypoxia: Change in skin colour, reduced oxygen saturation
- Need for CPR or mechanical ventilation in preterm/term baby
- Persistent pulmonary hypertension (fetal circulation)
- Oliguria persistent beyond 24 hours of birth
- Unexplained excessive bleeding, thrombocytopenia, abnormal coagulation
- Hypoglycaemia or hyperglycaemia
- Metabolic acidosis (base deficit >10mmol/litre)
- Local signs of infection (skin/eye)
- Signs of shock