Arly-The subject of treatment for suspected sepsis is one of the more hotly
debated subjects in neonatal care.  The prevalence of Group B Strep as a
normal vaginal flora is cause for worry since many newborns will be colonized
(not become ill, tho), and a FEW will develop an infection (sepsis).  Because
Group B Strep sepsis is such a serious illnes, with a substantial mortality
rate, AND because litigation on cases involving newborns is so wonderfully
common in our country, physicians are increasingly unwilling to take any
risks.  This translates to: Any woman with a history of + GBS cultures in
pgy., increased temp. in labor, prolonged Rupture of membranes (some use
other risk factors also) constitutes "at risk", and baby will be at least
"screened" for GBS sepsis at many/most institutions.  The Screening will
include some or all of these tests: Urine strep screening, Blood cultures,
CBC/diffs, plus others. There is a GREAT variance in the treatment regimen
for "at risk" babies, ranging from "watch this baby... to IV fluids/NPO,
Intermittent IV antibiotics for 2-3 days until culture & repeat CBC results
are in". Because strep sepsis seems to have increased in the last decade,
more and more kids end up on antibiotics, at least for a couple of days.
In my institution, "at risk" kids are screened for sepsis with Bld. cultures,
CBC/diff, and urine strep screen, and put on IV antibiotics via IV lock. No
continuous fluids, and not NPO (why NPO??).  They still breastfeed, and go to
Moms. It is still disruptive, and I don't like it, but they can successfully
breastfeed. ONe of the confounding factors about all of this is that there is
often NO definitive proof of sepsis in the newborn, even when the infant is
clinically very ill. Even then, blood cultures may remain negative.  The
testing is just not 100% reliable. We just treat empirically.  Hope this
helps a bit to clarify GBS issues. It is the bane of a neonatal nurse/LC's
exisitence (me)! Not to mention the physician...

Denise Mollenkopf, RNC, IBCLC
Florida