A question for the group. This new guideline apply to every gestational age. I just came up with a of a set twins that were born prematurely at 32+ weeks. Mother GBS status was unknown, babies were delivered by c-section due to breech presentation in one of them. ROM was at delivery. Both babies were born vigorous and transition without issues. The continued asymptomatic at a week of life. I decided to consider the recommendations of the 2010 GBS guidelines and did not start them on antibiotics. A CBC was reassuring and BCx was negative at 48hrs. Before the 2010 guideline, I would start any 34weeks or < preterm asymptomatic baby on antibiotics if the reason for preterm delivered was other than maternal due to the high association of preterm labor and sepsis.

1. What are you doing in your practice?

2. Are we missing an important window to prevent early-onset GBS or non-GBS sepsis in the most preterm and vulnerable baby?

3. Are we overusing antibiotics in this population? or this is not a big deal for most of us?

Thanks for any feedback on this!!

Previously we also used to do the same (CBC, CRP and blood CS) on all babies born to GBS positive untreated mothers but we changed our practice now, we do only CBC and CRP in asymptomatic newborn babies and if abnormal we do blood cs and treatment depend on clinical status.

Since your baby was clinically well, you did the right decision in my view.

1. What are you doing in your practice?

2. Are we missing an important window to prevent early-onset GBS or non-GBS sepsis in the most preterm and vulnerable baby?

3. Are we overusing antibiotics in this population? or this is not a big deal for most of us?

Thanks for any feedback on this!!

1. Would have taken the same decision in a scenario like that. But, the smallest indication of infection would change that decision. We also commonly take CRP and a blood culture with th first blood tests, to have it done in case we start ab later.

2. Possible, but the risk should be quite low, especially if the mother has recieved prepartal ab.

3. I don't think that the initiation of ab treatment is the problem here, but how long we use them. We need better methods for predicting abscense of infection, so we can give them as few days/doses as possible.

Thanks for the feedback.

There are some publications that bring concerns about the increased incidence non-GBS sepsis, particularly e'coli in premature infants after implementation of GBS guidelines. Some of my colleagues are concern that we may be ignoring this possibility by implementing the new guidelines which is focus on GBS only. Another argument is that the guideline does not address the more preterm and susceptible baby and we might be waiting until it could be too late to intervene. What's your take of these points?

Thanks

1- we are doing the same, limited evaluation + observation for 48 hours

2- I think we should restrict our antibiotics use to the minimum as we are seeing a lot of resistant organisms nowadays

Thanks

Though we have not implemented the new GBS guidelines fully, to a large extent we have come down on the usage of antibiotics and the labs requested. There is always a lurching fear of missing out on baby with sepsis, particularly in the preterm babies. So not following the guidelines fully in such circumstances are agreed upon by every one with out spelling it.