Group B streptococcal septicemia of the newborn (patient information)

# Overview
Group B streptococcal septicemia is a severe bacterial infection that affects newborn infants.

# What are the symptoms of Group B streptococcal septicemia of the newborn?
- Anxious or stressed appearance
- Blue appearance (cyanosis)
- Breathing difficulties such as:
- Grunting noises
- Flaring of the nostrils
- Rapid breathing
- Short periods without breathing
- Irregular heart rate - may be fast or extremely slow
- Lethargy
- Pale appearance (pallor) with cold skin
- Poor feeding
- Unstable body temperature (low or high)

# What causes Group B streptococcal septicemia of the newborn?
- The term septicemia refers to an infection in the bloodstream that may travel to different body organs. Group B streptococcal septicemia is caused by the bacterium Streptococcus agalactiae, which is commonly called "group B strep" or GBS. A newborn with septicemia is very sick.
- GBS is commonly found in adults and older children, where it does not usually cause infection. There are two ways in which it may be passed to a newborn baby:
- The infant can become infected as he or she passes through the birth canal. In this case, babies become ill between birth and 6 days of life (most often in the first 24 hours). This is called early-onset GBS disease.
- The infant may also become infected after delivery by coming into contact with people who carry the GBS germ. In this case symptoms appear later, when the baby is 7 days to 3 months or more old. This is called late-onset GBS disease.
- GBS now occurs less often, because methods to screen and treat pregnant women at risk are now being used.
- The following increase an infant's risk for group B streptococcal septicemia:
- History of giving birth to a baby with GBS sepsis
- Mother who has a fever (over 100.4 degrees F) during labor
- Mother who has group B streptococcus in her gastrointestinal, reproductive, or urinary tract
- Prematurity
- Rupture of membranes ("water breaks") more than 18 hours before baby is delivered
- Use of intrauterine fetal monitoring (scalp lead) during labor

# When to seek urgent medical care?
- This disease is usually diagnosed shortly after birth, often while the baby is still in the hospital.
- However, if you have a newborn at home who shows symptoms of this condition, seek immediate emergency medical help or call the local emergency number (such as 911).
- Parents should particularly watch for symptoms in their baby's first 6 weeks. The early stages of this disease can produce subtle symptoms.

# Diagnosis
- To diagnose GBS septicemia, GBS bacteria must be found in a sample of blood (blood culture) taken from a sick newborn.
- Other tests that may be done include:
- Blood clotting tests - prothrombin time (PT) and partial thromboplastin time (PTT)
- Blood gases (to see if the baby needs help with breathing)
- Complete blood count
- CSF culture (to check for meningitis)
- Urine culture
- X-ray of the chest

# Treatment options
- Treatment may involve one or more of the following:
- Antibiotics given through a vein
- Breathing help (respiratory support)
- Fluids given through a vein
- Medicines to reverse shock
- Medicines or procedures to correct blood clotting problems
- Oxygen therapy
- A complex therapy called extra-corporeal membrane oxygenation (ECMO) may be used in very severe cases.

# Where to find medical care for Group B streptococcal septicemia of the newborn?
Directions to Hospitals Treating Group B streptococcal septicemia of the newborn

# What to expect (Outlook/Prognosis)?
This disease can be deadly without prompt treatment.

# Possible complications
- Disseminated intravascular coagulation (DIC) - a serious disorder in which the proteins that control blood clotting are abnormally active
- Hypoglycemia - low blood sugar
- Meningitis - swelling (inflammation) of the membranes covering the brain and spinal cord caused by infection
- Respiratory failure - breathing stops

# Prevention
- The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and U.S. Centers for Disease Control and Prevention have established two methods to help reduce the risk of Group B streptococcal septicemia:
- Pregnant women are tested for group B streptococcus at 35 - 37 weeks into their pregnancy. If the bacteria are detected, women are given antibiotics through a vein during labor.
- Prenatal screening is not done, but a woman who meets certain risk factors is given antibiotics through a vein during labor.
- Both sets of procedures are currently accepted as the standard of care.
- Newborns who are at high risk are tested for GBS infection. They may receive antibiotics through a vein during the first 48 hours of life until blood culture results are available.
- In all cases, proper hand washing by nursery caretakers, visitors, and parents helps prevent the spread of the bacteria after the infant is born.
- An early diagnosis can help decrease the risk of some complications.

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