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"Enhanced observation" approach to evaluating neonates born ≥35 weeks gestation who are at risk for group B streptococcal infection

"Enhanced observation" approach to evaluating neonates born ≥35 weeks gestation who are at risk for group B streptococcal infection
GBS: group B Streptococcus; IAP: intrapartum antibiotic prophylaxis; LP: lumbar puncture; CSF: cerebrospinal fluid.
* Signs of infection in neonates are often nonspecific. Common findings include abnormal temperature (fever or hypothermia), respiratory distress, tachycardia, lethargy, poor feeding, apnea, bradycardia, and/or poor perfusion. For further details, refer to UpToDate topics on infections in neonates.
¶ If there is a strong clinical suspicion for infection, especially in neonates who are critically ill, it may be appropriate to perform LP and CSF culture in addition to the blood culture before starting empiric antibiotics. However, LP should not be performed if the procedure would compromise the neonate’s condition. Antibiotic therapy should not be deferred because of procedure delays.
Δ Empiric antibiotic coverage typically consists of ampicillin plus gentamicin. Refer to separate UpToDate content on treatment of neonatal GBS and neonatal sepsis for additional details.
For details regarding indications for IAP, refer to UpToDate's topic on prevention of GBS in pregnancy.
§ Adequate GBS IAP is defined as the administration of penicillin G, ampicillin, or cefazolin ≥4 hours before delivery.
Reproduced with permission from Pediatrics, Vol. 144, Page e20191881, Copyright © 2019 by the AAP.
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