Group B streptococcal septicemia of the newborn (patient information)

Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

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

What are the symptoms of Group B streptococcal septicemia of the newborn?

 * 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)

What causes Group B streptococcal septicemia of the newborn?

 * 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

When to seek urgent medical care?

 * 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.

Diagnosis

 * 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 options

 * 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.

Where to find medical care for Group B streptococcal septicemia of the newborn?
Directions to Hospitals Treating Group B streptococcal septicemia of the newborn

What to expect (Outlook/Prognosis)?
This disease can be deadly without prompt treatment.

Possible complications

 * 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

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.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/001366.htm