Pat Young writes:

  If GBS status is unknown baby gets CBC/diff and culture
>shortly after birth.


Is this adequate for effective treatment?  I have often wondered if infants
could be screened for GBS after birth and those with positive cultures
treated effectively. If so, it would be more medically sound to treat
*those* infants with abx rather than creating an unhealthy intestinal
environment for "all" infants (and their mothers), increasing infection
risk for a broader population.

The article that Leslie sent about the increase in e-coli induced infection
and sepsis is enlightening.  Thank you, Leslie, for sending it.

>In one study of more than 13,000 very low birth weight newborns at 15 US
centers, researchers found that rates of early-onset GBS sepsis fell
markedly between the early and late 1990s. That was accompanied,
however, by a comparable rise in early-onset sepsis caused by E. coli
bacteria ( news - web sites)--bugs that, most of the time, were
>resistant to the antibiotic ampicillin.

Later the article states that the drop in GBS induced infection is mirrored
by an increase in E.-coli infections. If this is the case it seems as if
there is no overall benefit to the infant population and, perhaps, more
harm because of the increase in abx-resistant bacteria.

If treating effectively for one bacteria with abx fosters the growth of
another bacteria that is resistant to treatment, then another approach to
this serious medical problem needs to be examined. This information needs
to get out to the medical community.

The level of abx use in birth in the US is a much more serious health
problem than most medical people realize. I suspect that few, if any, OBs
read the report that Leslie sent in. Routine screening and treating for GBS
perinatally will die hard because of a basic premise that birth is
dangerous and that the use of abx is "playing it safe."

I have had several client who tested *negative* for GBS but were given IV
abx before delivery (for several hours) "just in case."  And I have only
2-3 clients a month who *haven't* been given abx in the hospital.

There is much concern in the scientific and medical community about the
over use of abx in the US but its use is increasing instead of declining.
And the accompanying morbidity of the population accompanies this
indiscriminate use.

We, on Lactnet, will likely not resolve this serious health problem but we
can certainly begin to talk about it. This is not a case of GBS sepsis and
death vs. a case of thrush. The health issuea are much broader.

Thank you, Jay, for bringing it up and, again, Leslie for the most
informative article.

Pat Gima, IBCLC
Milwaukee, Wisconsin



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