NEONATAL GROUP B

STREP INFECTIONS
James Li, MD

OVERVIEW

Introduction
Classifications
Risk factors
Clinical Manifestations
Diagnosis/Evaluation

Management

INTRODUCTION

Group B Strep (GBS) encapsulated gram-positive diplococcus

found in 15 to 40% GI and genital tracts of pregnant women

Maternal colonization is THE primary risk factor for GBS

infection in infants younger than 90 days of age.

Rate of vertical transmission without intrapartum antibiotic

prophylaxis (IAP) 50%

Only 1-2 percent of all infants born to colonized pregnant women

develop early onset GBS disease

IAP has minimal impact to incidence of late onset GBS disease.

IAP only eliminates neonatal exposure during L&D. Women are

recolonized post partum.

Fatality rates

Term infants without meningitis 2 to 3%

Preterm infants 20%

CLASSIFICATIONS

Early onset GBS birth to day 6

Late onset GBS day 7 to 89 days
Late late onset GBS GBS beyond early infancy, past 3
months of age.

Most common in infants born before 28 weeks gestation, or

immunodeficiency

RISK FACTORS

Delivery at less than 37 weeks of gestation

Premature rupture of membranes
Prolonged rupture of membranes (18+ hours)
Chorioamnionitis
GBS BACTERIURIA!!!
Temperature greater than 38C, 100.4F during labor
Prior delivery of infant with GBS disease

CLINICAL MANIFESTATIONS

Early onset disease

Sepsis

Respiratory distress

Temperature instability

Hypotension

Tachycardia

Pneumonia

Radiographic findings

Diffuse alveolar pattern similar with hyaline membrane disease, transient

tachypnea of newborn

Pleural effusions more common in pneumonia vs. hyaline membrane

disease

Meningitis

Neurologic findings tremors, twitching, seizures, lethargy

Respiratory abnormalities

CLINICAL MANIFESTATIONS

Late onset disease

Bacteremia

Fever > 38C, 100.4F

Poor feeding, tachypnea, grunting, apnea

Meningitis

Other focal infection

Septic arthritis usually in lower extremities

Osteomyelitis usually humerus, femur, tibia

Cellulitis-adenitis

DIAGNOSIS/EVALUATION

CBC w/ differential
Blood culture
Chest Xray
Lumbar puncture CSF, protein, glucose, Gram stain, culture

LP, THEN antibiotics if possible

Urine culture

MANAGEMENT

Empirical Therapy

Principle broad coverage that cause early/late onset disease

GBS, other strep

Gram negative organisms

Listeria monocytogenes

Definitive Therapy

Principle treating GBS only, after identification

Penicillin G if patient has improved clinically

If GBS meningitis, repeat LP at 24 to 48 hours

MANAGEMENT

MANAGEMENT

REFERENCES

American Academy of Pediatrics. Group B streptococcal

infections. In: Red Book: 2015 Report of the Committee on
Infectious Diseases, 30th ed, Kimberlin DW (Ed), American
Academy of Pediatrics, 2015. p745

Eichenwald EC. Perinatally transmitted neonatal bacterial

infections. Infect Dis Clin North Am 1997; 11:223

Phares CR, Lynfield R, Farley MM, et al. Epidemiology of

invasive group B streptococcal disease in the United States,
1999-2005. JAMA 2008; 299:2056