Positive or unknown GBS

[MemphisOBRNC, BSN, RN]

Our pediatricians are keeping all babies of positive or unknown GBS mothers for 48 hours unless the mother got at least 2 doses of antibiotics, with the last dose being given at least 4 hours prior to delivery. If the delivery occurs prior to this, they are putting the babies on Amp. and Gent. and doing a CBC, CRP and blood cultures. The OB's are upset that there is a delay in discharge and we run out of rooms often. (We have LDRPs) What do your pediatricians do?

[tulsaL&D]

Our pediatricians used to go by that rule but now all they have to have is one dose of antibiotics (in for 4 hours). I'll try to find the policy tomorrow at work that shows the research done for the change they made.

[beckinben, CNM]

Sounds like serious overkill to me, in asymptomatic babies. Have they read the CDC guidelines? Do your OB's routinely treat unknowns? That is also not supported by the CDC guidelines.

Here they generally stay for 36 hours if they were unknown or inadequately treated (which is defined as 0 or 1 doses, if they got the second dose 5 minutes before delivery, that is considered adequate). Otherwise, they can go earlier.

Becki

[tdr61]

Our pediatricians are keeping all babies of positive or unknown GBS mothers for 48 hours unless the mother got at least 2 doses of antibiotics, with the last dose being given at least 4 hours prior to delivery. If the delivery occurs prior to this, they are putting the babies on Amp. and Gent. and doing a CBC, CRP and blood cultures. The OB's are upset that there is a delay in discharge and we run out of rooms often. (We have LDRPs) What do your pediatricians do?

I've worked in some facilities that still practice that way but I've noticed that many are moving away from that. Currently where I'm at, if the mom does not get at least 2 doses of antibiotics the peds will do a CBC, CRP and blood culture. No treatment is given unless the results are suspicious. They still keep the babies 48 hours or until they get the blood culture results back.

[Mrs.S]

or how about this...we have a ped who will order labs on babies born to GBS unknown moms by scheduled c/section. tell me the rationale for that??

[RNnL&D]

Our peds prefer 2 doses of Amp prior to delivery, with the second being at least one hour prior to delivery. The unassigned pedi group tends to keep untreated/under treated babes 48 hours, while some of our regular peds will dc at 24 hours if Mom desires, with an earlier office f/u.

None of our babies are treated unless symptomatic.

[babyktchr, BSN, RN]

or how about this...we have a ped who will order labs on babies born to GBS unknown moms by scheduled c/section. tell me the rationale for that??

Sounds to me like this ped needs some literature place on his/her desk for some education.

[QTBabyNurse, BSN, RN]

gbs positive or unknown (non treated or under treated) - babies get a cbc and blood culture drawn and stay 48 hours.

gbs positive and treated with 2 doses of pcn g - observe babies for 48 hours.

[eden]

For positive moms if at least 2 doses are not given baby will have a cbc and differencial done. If the diff comes back at greater the 30% then cultures are done and babies are started on amp and gent.

For unknown moms it's up to the OB if she is treated. Again if 0-2 doses not given, we proceed the same way as an inadequately treated positive mom.

As for whether the stay is 48hours, it depends on the dr. If differencial is negligable and baby is asymptomatic they will usually let them go at 36-40 hours. If differencial is high and/or baby is symptomatic, it's 48 hours.

[Krista77]

EEE GATS! I am new to couplet care (both moms and babies- came from 4 years adult ICU).... and I say eee gats!! because I'm reading all of your replies on how to handle a GBS unk/pos mom!

For our unknown moms- we don't do a dang thing, unless she was treated at all- then all we do is a CBC... depending on those results, we go from there (blood cultures, CRP, etc).

For our positive moms- all we do is get a CBC- call the results, and again- depending on what they are, we go from there.

Yikes! Are we not doing ENOUGH???

[RNfromMS]

At our hospital, we only treat moms with positive GBS cultures; 4 hour minimum treatment of PCN prior to delivery. That means PCN every 4 hours until delivery (unless allergic, then Clindamycin); if mom delivers at 4 hours after first dose, but does not get second dose started, it is ok. If mom delivers 3 hours 59 minutes after first dose, baby must be worked up and started on antibiotics. If mom is unknown, but with a history of GBS with prior pregnancy, peds does a work up and starts antibiotics; however, I don't know if they treat babies with unknown GBS and no prior history. If mom ever had a baby who was positive for GBS, her present status does not matter; she is treated in labor and baby is treated in tx is inadequate.

Two problems we have at our hospital. 1) If mom is GBS positive and has a ERCS without ROM, we do not treat but our peds treats baby. Apparently, the OB staff has found documentation supporting this, but Peds will not accept. 2) If mom is allergic to PCN, we treat with clindamycin, but Peds does not accept this as adequate treatment. Peds says clindamycin does not treat GBS; OB says it does. AAARRRGGG!

[SmilingBluEyes]

Sounds to me as if PEDS and OB need to get together. Seems ridiculous to me, to have to start an IV and abx tx on a newborn unless direly necessary. This is one case where the ounce of prevention certainly beats the pound of cure.