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Key Features

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  • Early-onset neonatal infection

    • Risk factors

      • Maternal GBS colonization

      • Low or absent maternal GBS anticapsular antibodies

      • Young maternal age

      • Rupture of membranes > 18 hours prior to presentation

      • Gestational age < 37 weeks

      • History of a previous infant with invasive GBS disease

      • African-American or Hispanic ethnicity

    • Newborn younger than 7 days, with rapidly progressing overwhelming sepsis, with or without meningitis

    • Pneumonia with respiratory failure is frequent; chest radiograph resembles that seen in hyaline membrane disease

    • Blood or cerebrospinal fluid (CSF) cultures growing group B streptococci (GBS)

  • Late-onset infection

    • Meningitis, sepsis, or other focal infection in a child aged 1–16 weeks with blood or CSF cultures growing GBS

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Clinical Findings

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  • Early-onset infection

    • Onset of symptoms in the majority of these infants is in the first 48 hours of life, and most are ill within 6 hours

    • Apnea is often the first sign

    • Sepsis, shock, meningitis, apnea, and pneumonia are the most common clinical presentations

    • When infection is complicated by meningitis, more than 80% of the bacterial isolates are serotype III

  • Late-onset infection

    • Occurs in infants between ages 7 days and 4 months (median age at onset is about 4 weeks)

    • Septic arthritis and osteomyelitis, meningitis, occult bacteremia, otitis media, ethmoiditis, conjunctivitis, cellulitis (particularly of the face or submandibular area), lymphadenitis, breast abscess, empyema, and impetigo have been described

    • Exact mode of transmission is not well defined

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Diagnosis

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  • Culture of GBS from a normally sterile site such as blood, pleural fluid, or CSF provides proof of diagnosis

  • Frequent false-positive results limit the usefulness of testing for GBS antigen in urine and CSF

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Treatment

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  • Intravenous ampicillin and an aminoglycoside is the initial regimen of choice for newborns with presumptive invasive GBS disease

  • For neonates 7 days of age or younger with meningitis, the recommended ampicillin dosage is 200–300 mg/kg/d, given intravenously in three divided doses

  • For infants older than 7 days of age, the recommended ampicillin dosage is 300 mg/kg/d, given intravenously in four divided doses

  • In infants with meningitis, the recommended dosage of penicillin G varies with age

    • For infants age 7 days or younger, 250,000–450,000 units/kg/d, given intravenously in three divided doses

    • For infants older than age 7 days, 450,000–500,000 units/kg/d, given intravenously in four divided doses

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