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Group B streptococcal septicemia of the newborn

Definition

Group B streptococcal septicemia is a severe bacterial infection that affects newborn infants.

See also: Neonatal sepsis

Alternative Names

Group B strep; GBS

Causes

The term "septicemia" refers to an infection in the bloodstream that may travel to different body organs. Group B streptococcal septicemia is caused by the bacterium Streptococcus agalactiae, which is commonly called "group B strep" or GBS. A newborn with septicemia is very sick.

GBS is commonly found in adults and older children, where it does not usually cause infection. There are two ways in which it may be passed to a newborn baby:

• The infant can become infected as he or she passes through the birth canal. In this case, babies become ill between birth and 6 days of life (most often in the first 24 hours). This is called "early-onset" GBS disease.
• The infant may also become infected after delivery by coming into contact with people who carry the GBS germ. In this case symptoms appear later, when the baby is 7 days to 3 months or more old. This is called "late-onset" GBS disease.

GBS now occurs less often, because methods to screen and treat pregnant women at risk are now being used.

The following increase an infant's risk for group B streptococcal septicemia:

• History of giving birth to a baby with GBS sepsis
• Mother who has a fever (over 100.4 degrees F) during labor
• Mother who has group B streptococcus in her gastrointestinal, reproductive, or urinary tract
• Prematurity
• Rupture of membranes ("water breaks") more than 18 hours before baby is delivered
• Use of intrauterine fetal monitoring ("scalp lead") during labor

Symptoms

• Anxious or stressed appearance
• Blue appearance (cyanosis)
• Breathing difficulties such as:
  • Grunting noises
  • Flaring of the nostrils
  • Rapid breathing
  • Short periods without breathing
• Irregular heart rate - may be fast or extremely slow
• Lethargy
• Pale appearance (pallor) with cold skin
• Poor feeding
• Unstable body temperature (low or high)

Exams and Tests

To diagnose GBS septicemia, GBS bacteria must be found in a sample of blood (blood culture) taken from a sick newborn.

Other tests that may be done include:

• Blood clotting tests - prothrombin time (PT) and partial thromboplastin time (PTT)
• Blood gases (to see if the baby needs help with breathing)
• Complete blood count
• CSF culture (to check for meningitis)
• Urine culture
• X-ray of the chest

Treatment

Treatment may involve one or more of the following:

• Antibiotics given through a vein
• Breathing help (respiratory support)
• Fluids given through a vein
• Medicines to reverse shock
• Medicines or procedures to correct blood clotting problems
• Oxygen therapy

A complex therapy called extra-corporeal membrane oxygenation (ECMO) may be used in very severe cases.

Outlook (Prognosis)

This disease can be deadly without prompt treatment.

Possible Complications

Possible complications include:

• Disseminated intravascular coagulation (DIC) -- a serious disorder in which the proteins that control blood clotting are abnormally active
• Hypoglycemia -- low blood sugar
• Meningitis -- swelling (inflammation) of the membranes covering the brain and spinal cord caused by infection
• Respiratory failure -- breathing stops

When to Contact a Medical Professional

This disease is usually diagnosed shortly after birth, often while the baby is still in the hospital.

However, if you have a newborn at home who shows symptoms of this condition, seek immediate emergency medical help or call the local emergency number (such as 911).

Parents should particularly watch for symptoms in their baby's first 6 weeks. The early stages of this disease can produce subtle symptoms.

Prevention

The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and U.S. Centers for Disease Control and Prevention have established two methods to help reduce the risk of Group B streptococcal septicemia:

• Pregnant women are tested for group B streptococcus at 35 - 37 weeks into their pregnancy. If the bacteria are detected, women are given antibiotics through a vein during labor.
• Prenatal screening is not done, but a woman who meets certain risk factors is given antibiotics through a vein during labor.

Both sets of procedures are currently accepted as the standard of care.

Newborns who are at high risk are tested for GBS infection. They may receive antibiotics through a vein during the first 48 hours of life until blood culture results are available.

In all cases, proper hand washing by nursery caretakers, visitors, and parents helps prevent the spread of the bacteria after the infant is born.

An early diagnosis can help decrease the risk of some complications.

References

Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Morbidity and Mortality Weekly Report. 51(RR-11): 1–22, 2002.

American Academy of Pediatrics Committee on Infectious Diseases. Group B streptococcal infections, in Section 3:Summaries of infectious diseases. Red Book 2009.

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