Dear Debi,

First I should introduce myself. I am a board-certified practicing pediatrician in a rural county in Northern Michigan. Right now I am the only pediatrician in the county. I am also a breast-feeding mother of Janet age 8 months and the niece of one of your IBCLC members. 

Regarding your beta-strep protocol, you didn't mention whether he is making this rule for all infants of mothers with beta strep or only for those whose mothers were not treated with antibiotics intra-partum. The difference is important as I look for articles for you since this is an area of medicine which is changing almost daily. A good place to start is the the AAP Committee of Infectious diseases and Committee of Fetus and Newborn Revised Guidelines for the Prevention of Early-Onset GBS infection in Pediatrics 1997; 99:493. This protocol basically is this:

If the mother is positive for GBS and gets > or = 2 doses of intrapartum antibiotics and the infant is well appearing and greater than or equal to 35 weeks then no evaluation or therapy is needed and the infant can be observed for 48 hours or more. This protocol by itself should return the vast majority of your babies to their mothers' rooms. 

I don't understand why blood work has to be done at 12 hours. Most sepsis protocols (for ill children) require that bloodwork be done immediately especially if antibiotics are going to be given to the child empirically. I would like to know the rationale for this wait. Certainly during my training, we didn't wait to do bloodwork if we thought that it was indicated. It seems to me that if it's needed, it should be done immediately and if it's not indicated then one has to question why one is doing it at all- but that's my opinion.

If no antibiotics are given to the mother or the infant is less than 35 weeks of age then the decision to test is up to the doctor and you won't have much effect at this point. Obviously, sick babies need to be treated. The high-risk group is trickier but will not be a very large portion of your population.

It might be interesting to check with large teaching hospitals near you about their protocols. Also, the whole point of the 48 hour observation is OBSERVATION and the last time I checked most mothers did a better job of that than a nursery nurse with multiple other children to look after. Sepsis in a newborn is a tricky thing at best- "sick" is hard to define and can be very subtle. I'm not sure that much is gained by putting these babies in the nursery. Why can't they do vitals every 4 hours in the rooms if they really feel that's needed? Also, I'm assuming by "vitals" they mean a rectal temp since axillary temps won't give them any information. I think that your moms may object to this if they only knew. 

I hope that this helps. You are welcome to email me directly if you need more information.

-Kate
Kate McIntosh MD FAAP
Benzonia, MI 
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