In a message dated 4/27/01 6:04:48 PM, Dr. Hertz writes:

<< My textbook gives the attack rate of  7.6 per 1000 and mortality rate of
33%
for GBS infected infants who are less than 2500 grams, had ruptured
membranes greater than 18 hours and maternal temperature greater than 37.5
degrees.
For infants without the above risk factors the attack rate is 0.6 per 1000
and the mortality rate is "only" 6%.
These babies can get very sick, very quick.
 >>

Math:  .6 per 1000 times .06 mortality rate equals .0036 deaths per 1000
infants without risk factors which is he same as 3.6 deaths per 1,000,000 or
about 1 per quarter million.  Not much, but certainly nothing to scoff at
either when it looks to preventable.

The big problem I have is that I have lost a lot of faith in the
neonatologists who do these studies and generate these numbers.  These are
the same docs who absolutely discount the side effects of "Amp+Gent" for any
baby that breaths faster than 60/minute and give glucose water for
ever-changing "hypoglycemia" criteria in otherwise healthy babies.

The same docs who are far too often shortsighted about breastfeeding and have
fought breastfeeding in every NICU I have worked in or heard of because the
believe drug reps about HMF and believe their own studies about adverse
affects of nursing on premies homeostasis.

I, too, have seen fatal neonatal GBS.  Not for a long, long time, but I know
it exists.  These guidelines could be relaxed for mothers in excellent
health with optimal prenatal and neonatal support.  And, for those who have
the potentially "unrisk" factor of breastfeeding.

There is no easy answer because fetal exposure to medicines is not good and
thrush is one nasty infection to treat.

There is no good answer for moms who want to skip the antibiotics when GBS
positive.  I tell them it is my strong feeling that we underestimate the
negative impact of such freely given meds but that there is absolutely NO
other accepted safe way to treat the condition.

I have decided that because I continue to recommend breastfeeding for a
duration which is years greater than the cultural norm, the family bed for
years, too and support other alternatives outside of the mainstream, I will
nod my head in assent, albeit reluctantly, about GBS prophylaxis, wear a
nice, grown-up tie to work each day, and await more definitive guidelines for
the lowest risk mothers and babies.

Jay Gordon, MD, FAAP, IBCLC

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