Group B streptococcal septicemia of the newborn

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

  • Alternative Names
    • Group B strep; GBS; Neonatal sepsis

  • Causes
    • Septicemia is an infection in the bloodstream that may travel to different body organs. Group B streptococcal (GBS) 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, and usually does not cause infection. There are two ways in which it may be passed to a newborn baby:

      • The infant can become infected as the baby 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 there are methods to screen and treat pregnant women at risk.

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

      • Being born more than 3 weeks before the due date (prematurity), especially if the mother goes into labor early (preterm labor)
      • Mother who has already given birth to a baby with GBS sepsis
      • Mother who has a fever of 100.4°F (38°C) or higher during labor
      • Mother who has group B streptococcus in her gastrointestinal, reproductive, or urinary tract
      • Rupture of membranes (water breaks) more than 18 hours before the baby is delivered
      • Use of intrauterine fetal monitoring (scalp lead) during labor
  • Symptoms
    • The baby may have any of the following signs and symptoms:

      • Anxious or stressed appearance
      • Blue appearance (cyanosis)
      • Breathing difficulties, such as flaring of the nostrils, grunting noises, rapid breathing, and short periods without breathing
      • Irregular or abnormal heart rate, they may be fast or very 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
    • The baby is given antibiotics through a vein (IV).

      Other treatment measures may involve:

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

      A therapy called extracorporeal membrane oxygenation (ECMO) may be used in very severe cases.

  • Outlook (Prognosis)
    • This disease can be life threatening 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, or low blood sugar
      • Meningitis: swelling (inflammation) of the membranes covering the brain and spinal cord caused by infection
  • 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 watch for symptoms in their baby's first 6 weeks. The early stages of this disease can produce symptoms that are hard to spot.

  • Prevention
    • To help reduce the risk of GBS, pregnant women should get tested for the bacteria at 35 to 37 weeks into their pregnancy. If the bacteria are detected, women are given antibiotics through a vein during labor. If the mother goes into premature labor before 37 weeks and GBS test results are unavailable, she should be treated with antibiotics.

      Newborns who are at high risk are tested for GBS infection. They may receive antibiotics through a vein during the first 30 to 48 hours of life until test results are available. They should not be sent home from the hospital before 48 hours of age.

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

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

  • References
    • Committee on Infectious Diseases; Committee on Fetus and Newborn, Baker CJ, Byington CL, Polin RA. Policy statement -Recommendations for the prevention of perinatal group B streptococcal (GBS) disease. Pediatrics. 2011;128:611-6. PMID 21807694

      Lachenauer CS, Wessels MR. Group B streptococcus. In: Kliegman RM, Stanton BF, St. Geme JF III, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 177.