Group B streptococcus (Streptococcus agalactiae) lives harmlessly in the gut and vagina of many women but can infect the baby at birth. It is a leading cause of newborn sepsis, pneumonia and meningitis, so pregnant women are screened and given antibiotics in labor.
Key symptoms
- Fast breathing, grunting or pauses in breathing
- Poor feeding
- Sleepy or floppy baby
- Fever or low temperature
- Irritability or seizures in late-onset disease
What you find on exam
- Breathing rate, retractions, nasal flaring and oxygen saturation
- Heart rate, capillary refill and mottled skin
- Low muscle tone and weak cry
- Bulging fontanelle, which suggests meningitis
- Review mother's GBS status, intrapartum antibiotics and rupture of membranes
Tests
- Blood culture before antibiotics
- Blood count, CRP and blood glucose
- Lumbar puncture for CSF cell count and culture
- Chest X-ray if breathing problems
Treatment basics
- Empiric IV ampicillin plus gentamicin
- Narrow to penicillin G or ampicillin once GBS is confirmed
- 10 days for bacteremia, 14 days or more for meningitis
- Support oxygen, breathing, fluids and glucose
- Prevention: maternal screening at 36 to 37 weeks and IV penicillin in labor
Red flags
- Apnea or grunting with retractions
- Poor perfusion or low blood pressure
- Seizures or bulging fontanelle
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.