What are the management steps for a term patient with a history of Guillain-Barré Syndrome (GBS) who received treatment just before delivery and has a healthy baby?

Management of a Term Newborn After Maternal History of GBS with Penicillin Administration Before Delivery

For a term newborn who appears healthy after delivery with maternal history of GBS and penicillin administration 30 minutes before delivery, routine care and observation for 48 hours is recommended due to inadequate intrapartum antibiotic prophylaxis.

Assessment of Intrapartum Antibiotic Prophylaxis (IAP) Status

• Adequate IAP is defined as penicillin, ampicillin, or cefazolin administered for at least 4 hours before delivery 1
• In this case, penicillin was given only 30 minutes before delivery, which is considered inadequate IAP 1
• Only penicillin, ampicillin, and cefazolin are considered specific for GBS treatment; other antibiotics are not considered adequate prophylaxis 1

Management Algorithm for Term Newborn with Inadequate IAP

For Well-Appearing Term Infant with Inadequate IAP:

• Since the infant is term and appears healthy ("looks good") with inadequate IAP (penicillin given <4 hours before delivery), the following is recommended:
  • Observe the infant for at least 48 hours for signs of sepsis 1
  • No laboratory tests are required if the infant remains well-appearing and rupture of membranes was <18 hours 1

Additional Considerations:

• If the rupture of membranes was ≥18 hours before delivery, a limited evaluation should be performed, including:

  • Complete blood count (CBC) with differential 1
  • Blood culture 1
  • Observation for at least 48 hours 1

• The sensitivity of the CBC is improved if delayed for 6-12 hours after birth 1

Discharge Considerations

• If the infant remains well-appearing and meets other discharge criteria, discharge can occur as early as 24 hours after birth with follow-up care by a healthcare provider within 48-72 hours 1
• This early discharge is only appropriate if:
  • The infant is term (which is the case here)
  • Ready access to medical care is available
  • A person who can comply fully with instructions for home observation will be present 1, 2
• If any of these conditions is not met, the infant should be observed in the hospital for at least 48 hours 1, 2

Signs of Sepsis Requiring Immediate Intervention

• If the infant develops any signs of sepsis (tachycardia, tachypnea, lethargy, poor feeding, temperature instability), immediately perform:
  • Full diagnostic evaluation including blood culture 1
  • Lumbar puncture if the infant is stable enough 1
  • Start empirical antimicrobial therapy promptly (typically intravenous ampicillin and gentamicin) 1
  • Empirical therapy should be discontinued as soon as clinical course and laboratory evaluation exclude sepsis 1

Special Considerations for Maternal Guillain-Barré Syndrome (GBS)

• While the question mentions maternal history of GBS, it appears to be referring to Group B Streptococcus rather than Guillain-Barré Syndrome based on the context 3, 4
• If the mother truly has Guillain-Barré Syndrome, this neurological condition does not directly affect management of the newborn, though it may impact maternal recovery 3, 5
• The focus should remain on adequate observation of the infant for signs of early-onset Group B Streptococcal disease 1