Group B streptococcal septicemia of the newborn
    
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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.

Alternative Names

Streptococcus agalactiae; Sepsis of the newborn; Lancefield group B streptococcus; Group B streptococcus

Causes

Group B streptococcal septicemia is caused by Streptococcus agalactiae, a type of group B streptococcus bacteria, which is commonly found in the human gastrointestinal, reproductive, and urinary tracts.

The disease may be seen from birth to 6 days of life (generally in the first 24 hours) or in children age 7 days to 3 months. Most cases occur in babies around 1 month old.

Group B streptococcus was once responsible for about 75% of sepsis infections in infants. However, the rate of this condition has dropped since methods to screen and treat pregnant women at risk were established.

The following increase the risk for group B streptococcal septicemia:

  • Mother has a fever during labor
  • Mother has group B streptococcus in her gastrointestinal, reproductive, or urinary tracts
  • Rupture of membranes ("water breaks") more than 18 hours before baby is delivered
  • Prematurity

Group B streptococcus may infect the fetus by traveling from the mother's bloodstream through the placenta or through ruptured membranes as the infant passes through the birth canal. The infant may also become infected after delivery.

Symptoms

Parents should watch for any of the following symptoms when their child is less than 3 months old, particularly in the first 6 weeks. The early stages of the disease can produce subtle symptoms. Parents should contact their doctor if they are concerned that symptoms are developing.

Symptoms may include:

  • Unstable temperature (low or high)
  • Poor feeding
  • Baby appears unwell, stressed, or anxious
  • Breathing difficulties
    • Grunting
    • Flaring of the nostrils
    • Rapid breathing (tachypnea)
    • Short periods without breathing (apneic episodes -- see apnea)
    • Blue appearance (cyanosis)
  • Irregular heart rate - may be fast (tachycardia) or extremely slow (bradycardia)
  • Irregular heartbeat (arrhythmia)
  • Lethargy
  • Coma
  • Shock

Exams and Tests

  • Blood culture (grows group B strep)
  • CSF culture
  • Urine culture (see urine collection - infants)
  • CBC (complete blood count)
  • Chest x-ray
  • Blood gases
  • PT and PTT

Treatment

Treatment may involve one or more of the following:

  • Antibiotics given by IV (intravenously)
  • Fluids (given by IV)
  • Medicines to reverse shock
  • Medicines or procedures to correct blood clotting problems
  • Oxygen therapy
  • Breathing help
  • ECMO (Extra Corporeal Membrane Oxygenator) in very severe cases

Outlook (Prognosis)

This disease can be deadly without early treatment.

Possible Complications

Possible complications include:

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 signs of this condition, seek immediate emergency medical help or call the local emergency number (such as 911).

Prevention

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

  1. Pregnant women are tested for group B streptococcus at 35 to 37 weeks of pregnancy. Those who show presence of the bacteria are given antibiotics through an IV during labor.
  2. Prenatal screening is not done, but women are given antibiotics through an IV during labor (if they meet certain risk factors).

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

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