What care should be provided to a healthy-appearing newborn whose mother received penicillin (antibiotic) within 30 minutes of birth due to Group B Streptococcus (GBS) infection?

Management of a Healthy Newborn After Inadequate GBS Prophylaxis

For a healthy-appearing newborn whose mother received penicillin less than 30 minutes before delivery for Group B Streptococcus (GBS) colonization, the baby should undergo a limited evaluation (blood culture and CBC with differential) and be observed in the hospital for at least 48 hours. 1

Assessment of Prophylaxis Adequacy

• Adequate intrapartum GBS prophylaxis is defined as ≥4 hours of IV penicillin, ampicillin, or cefazolin before delivery 1
• Administration of antibiotics less than 30 minutes before delivery is considered inadequate prophylaxis 1

Management Algorithm for This Healthy-Appearing Newborn

Step 1: Determine Risk Category

• Mother had GBS colonization requiring prophylaxis 1
• Prophylaxis was inadequate (penicillin given <30 minutes before delivery) 1
• Baby appears healthy with no signs of sepsis 1

Step 2: Implement Appropriate Management

• Perform limited evaluation including:
  • Blood culture (at birth) 1
  • Complete blood count (CBC) with differential and platelets (at birth and/or at 6-12 hours of life) 1
• Observe the infant in the hospital for ≥48 hours 1

Step 3: Monitor for Signs of Sepsis

• Watch for signs of early-onset GBS disease including tachycardia, tachypnea, lethargy, temperature instability, and poor feeding 1
• If signs of sepsis develop, conduct a full diagnostic evaluation (including lumbar puncture) and initiate antibiotic therapy 1

Special Considerations

• Gestational age matters:

  • If the infant is ≥37 weeks AND membrane rupture was <18 hours, observation alone may be sufficient 1
  • If the infant is <37 weeks OR membrane rupture was ≥18 hours, the limited evaluation described above is necessary 1

• Early discharge is not recommended:

  • The infant should remain in the hospital for the full 48-hour observation period 1
  • Early discharge (after 24 hours) is only appropriate for infants ≥37 weeks whose mothers received adequate prophylaxis 1

Important Caveats

• Penicillin given shortly before delivery does not reliably prevent early-onset GBS disease 2
• Penicillin fails to eradicate GBS from mucous surfaces in many infants despite treatment 3
• Even if blood cultures remain negative during observation, vigilant monitoring is essential as early-onset GBS disease can develop rapidly 1
• The combination of ampicillin and gentamicin may be more effective than penicillin alone if treatment becomes necessary 4

Follow-up Recommendations

• If the infant remains well throughout the observation period and all cultures are negative, no antibiotics are needed 1
• Parents should be educated about signs of late-onset infection to monitor for after discharge 1
• Ensure appropriate follow-up care is arranged before discharge 1