Beta Strep

Elvish, BSN, DNP, RN, NP · Aug 18, 2011

I think latest evidence is that abx cross the placenta in about an hour, but my place still cultures babies if it was

If mom is ROMed we treat, if not we don't when it comes to c/s. Keep in mind, though, most cases of GBS sepsis come from babies whose moms tested neg,

TLSpaz, ASN, RN · Aug 18, 2011

If mom is ROMed we treat, if not we don't when it comes to c/s. Keep in mind, though, most cases of GBS sepsis come from babies whose moms tested neg,

Would you mind telling me where I can read more about that particular statistic, please? It seems that this would be true and yet at the same time be the result of some type of a logical fallacy. Since we are testing everyone now, then those who are positive are treated (except of course in cases where labor/delivery is not "routine"-precip, trauma, etc...) If we didn't treat all positives prophilactically then I would think that it stands to reason we would see significantly more cases of sepsis in positives than in false or true negatives. Also, I am interested to know numbers on those cases of sepsis which were early onset vs. late onset, leading me to ask if baby actually contracted from mom or from some other exposure? If my thinking is totally wrong here, please advise. I am here to learn....

Also, what are your thoughts on how I can best introduce current evidence-based interventions when those interventions are counter to the status-quo? How do I question the status quo from a position of simply not understanding, without seeming like I am questioning from a place of defiance? I want to play well with others but I want to, more importantly, give the best, current, evidence-based care. I kind of feel like I got told "Because I said so" today. I don't think I am out-of-line for wanting to know a rationale for or against a particular practice.

Elvish, BSN, DNP, RN, NP · Aug 18, 2011

I learned that particular statistic on a CE lecture on neonatal sepsis earlier this year, but I will look for a link. The lecturer explained it that women get tested at 35-37 weeks, but most don't deliver for several weeks after that. Between testing and delivery they can be colonized with GBS but they're still on record as being GBS neg. The figure is somewhere in the ballpark of 10%. My guess is that because we know about the GBS+ moms, we can treat them in labor and their infants have a reduced incidence of sepsis....with GBS- moms, no treatment happens but their infants are still exposed if they've been colonized between culture and delivery. That's my guess.

I'll look for something later today...up right now feeding the baby. :)

NurseNora, BSN, RN · Aug 21, 2011

Remember that most babies, even from GBS + moms who aren't treated will be negative. No, I do 't have the reference on that, I'll leave it to you to look up. The most importa t thing is to watch the infant for S/S of GBS infection. That's true even if a mom was treated prior to delivery or was negative

Ask your Peds docs what they do if a C/S mom was ruptured. Some of ours will do blood cultures, or prophylactic antibiotics, or just watch carefully for S/S of infection.

Also talk to your OB docs.about their practice and why thet do what they do. That' one way of getting answers to your questions without seeming to rag on your preceptor.