Review Question - QID 105436

This patient has neonatal sepsis secondary to Group B Streptococcal (GBS) infection, which could have been prevented with appropriate maternal screening and antibiotic therapy during pregnancy.

GBS is a bacteria that is commonly found as a colonizer of anal and genital mucosal surfaces. While it rarely causes clinical infection in adults, GBS is the leading cause of sepsis in neonates. Pregnant women are routinely screened for GBS colonization, and if present they are treated with penicillin.

Apgar et al. discuss strategies for the prevention of GBS disease in newborns. They stress the importance of screening during gestation. Penicillin is the preferred antibiotic; however, other possibilities include clindamycin and erythryomycin for women with anaphylactic reactions to penicillins. They also note that administration of antibiotics to high risk infants reduces GBS sepsis by as much as 80 to 95 percent.

Gerdes reviews bacterial infections in neonates. He notes that bacterial sepsis in neonates is a low incidence, high risk disease, and that GBS sepsis has been significantly reduced, but not eliminated. Neonates do not always present with the classic signs of infection (fever, tachycardia, hypotension, etc.), and thus it is important to maintain a high index of suspicion when considering the possibility of bacterial infection in a neonate.

Illustration A demonstrates the indications for intrapartum prophylaxis for women screened for GBS during pregnancy.

Incorrect Answers
Answers 1 & 2: There are currently no vaccinations that prevent colonization with GBS or infection.
Answer 4: While newborns are giving antibiotic eye drops at birth, no other antibiotic therapy is routinely given to neonates.
Answer 5: Maternal treatment with penicillin could have helped prevent this patient's neonatal sepsis.