title: Unnecessary workup of asymptomatic neonates in the era of group B streptococcus prophylaxis.
abstract: Asymptomatic term neonates born to mothers who are Group B Streptococcus (GBS) unknown or GBS positive but "inadequately" treated prior to delivery do not require invasive laboratory evaluation. We conducted a retrospective cohort study of mother/baby dyads born from January 1, 2005 until September 30, 2007 at the Medical College of Georgia. Their current protocol is to obtain a Complete Blood Count with Differential (CBC with D), Blood Culture (BC), and C-reactive protein (CRP) after birth. Mother/baby dyads (n = 242) that met inclusion criteria were reviewed. Of these 242 babies 25 (10%) were started on antibiotics after the initial lab values were known. None of the blood cultures were positive and the CRP's were normal. The 2002 GBS guidelines call for laboratory evaluation of "at-risk" neonates, but the workup of these babies is not only costly, it does not provide any advantage over old fashioned clinical observation for the evaluation and treatment of early onset GBS sepsis.
authors.affiliation: Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912, USA. bbuckler@mcg.edu
authors.forename: Brad
authors.initials: B
authors.lastname: Buckler
authors.forename: Jason
authors.initials: J
authors.lastname: Bell
authors.forename: Ralph
authors.initials: R
authors.lastname: Sams
authors.forename: William
authors.initials: W
authors.lastname: Cagle
authors.forename: Sue Anne
authors.initials: SA
authors.lastname: Bell
authors.forename: Carla
authors.initials: C
authors.lastname: Allen
authors.forename: Don
authors.initials: D
authors.lastname: Sutherland
authors.forename: Jatinder
authors.initials: J
authors.lastname: Bhatia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
references.citation: MMWR Recomm Rep. 2002 Aug 16;51(RR-11):1-22
references.pmid: 12211284
references.citation: Am J Obstet Gynecol. 2007 Dec;197(6):583.e1-4
references.pmid: 18060942
references.citation: Obstet Gynecol. 1998 Jan;91(1):112-4
references.pmid: 9464732
references.citation: Am J Obstet Gynecol. 1996 Oct;175(4 Pt 1):974-6
references.pmid: 8885758
references.citation: Pediatr Infect Dis J. 2003 May;22(5):430-4
references.pmid: 12792384
references.citation: N Z Med J. 2004 Aug 20;117(1200):U1023
references.pmid: 15475993