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Andrew B. Kairalla MD, Editor

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New GBS Prevention Guidelines
Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC.
 Schrag S, Gorwitz R, Fultz-Butts K, et al.  MMWR 2002; 51(R11):1-22.

 Summary of New Neonatal Management

1.     Management of infants born to women suspected of having chorioamnionitis.

      Ø       Designates change or addition to 1996 CDC guidelines.
ü      
Designates reiteration of 1996 CDC guidelines.

Ø       If a woman receives intrapartum antibiotics for treatment of suspected chorioamnionitis, her newborn should have a full diagnostic evaluation and empiric therapy (e.g. ampicillin and gentamicin) pending culture results, regardless of clinical condition at birth, duration of maternal antibiotic therapy before delivery, or gestational age at delivery.  


 Suggested Discussion Points:

1.       How will we identify which mothers were given intrapartum antibiotics for “suspected chorioamnionitis”?

2.       Do obstetricians need to be made aware that the label of “suspected chorioamnionitis” has new clinical implications for the evaluation and treatment of the baby? 


 Comment:  It now becomes imperative to ascertain the indication for intrapartum antibiotic treatment.  If the obstetrician is treating suspected chorioamnionitis, then we automatically need to do a sepsis evaluation and start antibiotics on the baby.  We need a system in place which assures timely notification of pediatricians or neonatologists when babies are delivered to women with suspected chorioamnionitis. ABK.
 

Additional Comments

Date:        22 Dec 2002
Time:        21:29:40

The summary recommends "full workup" and abx for infants whose mothers are dx'd with chorio, regardless of the infant's presentation.

These recommendations do not seem reasonable in light of the overwhelming number well infants born under these circumstances, the overwhelming number of negative evaluations performed, and with acknowledgement that ~95% of infants with EOGBS will be symptomatic within 6 hrs of birth (Bromberger et al, Pediatrics 106:6;244-250). 

UserName:    Ken Schroeter, DO, FAAP
Institution: Stony Brook University
telephone:   631-444-7653
email:       Kenneth.Schroeter@stonybrook.edu


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