Thanks to Melinda Hoskins for her description of babies with GBS sepsis. (Aug 23, 2000 #2000-994) She gives a very vivid picture of this problem. As she says, one of the difficult things about GBS sepsis is that it's onset is often insidious and rapid. If diagnosing those who have the infection was easy, this would not be such a contentious issue.

There are two sorts of GBS invasive disease in infants. The first occurs within the first 24 hours. The second is "late-onset" usually occurring between 3-4 weeks of age but the range is 7days to 3 months. The protocol is question is set up to catch the first set- those with early onset disease. 

The first symptoms of sepsis are subtle- often respiratory with tachypnea or apnea rapidly progressing to pneumonia, shock, and occasionally meningitis. The problem with this is that newborns (as we know) rarely do anything by the rules. The very first signs may be a subtle as hypothermia, not feeding well, or just plain "looking bad". There was a study once whose reference I have forgotten which found that the only really good determining factor of a "toxic" infant was the "gut feeling of an experienced pediatrician". These are not the sort of criteria which inspire confidence or comfort! It is for this reason that many physicians are quick to evaluate babies with laboratory criteria (which are also difficult to interpret in newborns!) 

The data which I have seen really suggests that the solution probably lies in prevention and in treating the mother intrapartum. By the time one of these babies shows up, pediatricians are usually just trying to put bandaids on an already critical situation.

I hope that this helps some- I am not an expert on GBS sepsis and there may be someone out there who is who has more experience and input.

Sincerely,

Kate
Kate McIntosh MD FAAP
Benzonia, MI 
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