Positive or unknown GBS

[MemphisOBRNC]

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?

[sharann, BSN, RN]

Since I don't care for many C-section(a couple a day in our PACU maybe 3), can you tell me why the antibiotic can be given 5 minutes before delivery? This is what I see them doing where I work.Does it circulate to the baby that fast? This is routine for all C-sections right? Thanks.

[MemphisOBRNC, BSN, RN]

The pre-op antibiotic for a CS is for the mother's benefit. Unless the mother is in labor or has ruptured membranes, she does not get the Pen-G for the benefit of the baby for a CS delivery. Unless mom is allergic to Ancef, we routinely give 2 grams just prior to going to the CS room.

[nurseglad]

Hi

In the UK it's standard procedure to treat all labouring GBS women with IV stat dose of 3gms Benzylpenicillin, and 1.5 gms IV 4 hourly thereafter until the the baby is delivered. If the mother receives less than 2 doses then the baby is given IV Pen and Gent for at least 48 hours...more often than not they stay for 4-5 days and have the IVs, causing a huge uptake of available beds...(remember it's all free treatment here:chuckle ) But because the paeds are afraid of litigation this is the way they practice :smackingf

[nurseglad]

we also treat the GBS moms with an allergy to Benzylpenicllin with clindamycin IV, and all over the UK the paeds here think it's a good prophylactic therapy for the babies.

[lovemyjob]

we do workups on all gbs unknown and positive-inadequatly treated (being 1st dose less than four hours prior to delivery.) and treat onl those with indications in bloodwork. If during their stay they become syptomatic, blood is redrawn and abx started. Cant remember the d/c depending on gbs status....

[lovemyjob]

oh, and our peds dont recognize clinda as an abx for gbs either.....

[Justhere, BSN, RN]

If GBS + or unknown, if they don't get treated x's 2 with Amp or clinda then we get a cbc with diff, and BC. Depending on the results if we treat baby or not.

[midwife2b]

Penicillin allergic patients who are GBS positive have an automatic sensitivity done because we are finding that clinda is not always sensitive to some GBS (sounds like mutation is happening). We've had to put some on Vanco which is killer expensive because that was the only thing that the GBS was sensitive to.

There is some documentation that clinda isn't the best drug. But the CDC guidelines have not changed yet.

[Mimi2RN, ASN, RN]

We do CBC and BC at 4 hours of age if mom is pos or unk GBS. If the baby is symptomatic, or the lab results are funky, we treat with Amp and Cefotaxime for at least 6 doses. If we get a positive culture, they are admitted for at least a week, sometimes longer.

Babies are kept for 48 hours, as mom can stay that long with a vag delivery, it's not a problem. We do couplet care, so baby is with mom the whole time.

It seems like we go overboard, but one baby going bad is enough to change your whole view of GBS. I don't understand OB's who don't give abx to moms who have been ruptured for many hours. OK, mom may have been negative at 36 weeks, but who knows what their status is at delivery!

[nursecave]

At our facility, a GBS + mom, gets Pen-G (unless allergic, then it is CLinda). As long as the dose is in 4 hrs or longer she is considered adequately treated. For unknown GBS, we look at other risk factors, such as 18 hrs, to determine if we will place the baby on protocol. The teaching DR's for the unassigned babies usually want CBC/D and BC, the private MD's just have us watch for symptoms for unknown GBS. For C/S with no ROM until delivery, we don't do anything, GBS ?, GBS +, it doesn't matter as long as there was no ROM until delivery. For babies with symptoms, they go to NICU for IV abx. For asymptomatic babies, we observe for 48 hrs, then they go home. Our policy has evolved countless ways in the 5 1/2 years I have been there, but the latest policy seems to be the best. Very rarely does a baby get to NICU for abx and later come up with a negative culture.

[tinyscrafts]

I've heard there is a new very fast test (test the moms) for GBS that we might be able to use when moms come in for delivery. Has anyone got it yet? I wonder how long it will take to actually be used.