Dear Catherine,

The length of the course of IV antibiotics would depend on where the baby
grows the group B strep. I am not sure what 'cbc' is that you mentioned in
your post,
but  by the sounds of the baby's condition, it is not very sick. Group B
strep. infections
can be very nasty. The morbidity rate of the babies born to mothers with
group B strep
infections is about 2-4 per 1000 and the perinatal mortality rate is 1 in
1000. ( Beischer Mackay.
Obstetrics and the Newborn)
Typically these babies present with a respiratory distress and septicaemia
but a late onset form
 presents as a lethargic, anorexic and jaundiced infant, with meningitis as
a common complication.
If the cbc you mentioned was an abbreviation for blood culture then
antibiotics would need to
continue for a full 5 day course but I can see no reason for the baby not
having oral feeds unless it
is unwell. The brownish fluid that was spat up by the baby was probably old
blood from the vigorous
 suctioning or from the birth canal and this could have some influence on
the way she felt about feeding
initially, she may well have felt rather nauseous with blood in her tummy!!
So, Group B is not one to be messed with and the antibiotics are warranted
but maybe the NPO
is not. This needs to be clarified with the attending medical personnel as
to *why*?

Hope this is of some help,
Janelle Gridley RN


>HELP, especially physician members:
>        I was labor support for my friend last night.  She had PROM (48
>hours), 100.4 degree F fever, and fetal tachycardia (180 baseline with no
>beat-to-beat variability) and a positive group B Strep culture.  Maternal
>fever resolved with acetaminophen 1000mg and fetal heart rate improved with
>left lateral recumbent position and O2.  The midwife and OB pushed the labor
>with pit and encouraged strenuous pushing, and baby girl was 7/9 (1/5 min
>Apgars) with no tachypnea or evidence of infection.  After vigorous suctioning
>for thick mucous, and examination, baby went to mom for about 30 mins of
>snuggling and attempt to bf.  Baby did not latch, but did mouth the nipple a
>tiny bit.  (Mom is a LLL Leader).  I was concerned by baby's failure to cry
>when seperated from mom for medical procedures, she did not seem really "with
>it".
>        After seperate exams by ped resident, neonatology fellow, and the
>attending ped; baby was transported to Intermediate care nursery and started
>on iv antibiotics.  After recovery, mom went to NICU to nurse, and it took her
>1.5 hours to encourage baby to latch, baby sucked 20 mins "but it didn't feel
>right, it felt like she was chewing a bit."  Two hours later, mom got baby
>latched again and baby fed for 25 mins.  Change of shift occured and nurse
>took baby as all babies must be in isolettes at change of shift (hosp policy).
> Mom did not have a chance to burp baby.
>        When mom went back to feed again, baby had a small amount of curdled
>milk and yellow-brown fluid on her face, as if she had spit up.  Nurse said
>that new babies are often "juicy" and not to worry.  Baby refused to latch at
>all at this feeding as well as the next 2.  The next time mom went to feed,
>the resident ped had put baby on npo (nothing by mouth for the latin and greek
>challenged), solely due to the labor history.  The same resident told mom
>"don't worry, you have no milk to feed her yet anyway."  I advised mom to
>pump, and she got plenty of colostrum.
>        The babies cbc was positive for B strep this morning(Fri.), though the
>culture will not be grown out until Sat pm.
>        The resident is telling mom baby will have to stay 7 days instead of
>the 2 days they were originally told.
>        Mom is angry at the npo status, and does not know if this is
>warranted.  How long is iv antibiotic treatment warranted for an infant with
>this history?
>TIA.
>Catherine Watson Genna, IBCLC
>
>
Ross & Janelle Gridley
Bendigo, Victoria, Australia
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