What are the implications of Group B Streptococcus (GBS) on neonatal pneumonia?

From the Guidelines

Group B Streptococcus (GBS) pneumonia in neonates requires immediate treatment with intravenous antibiotics, and the recommended regimen is ampicillin plus gentamicin for at least 10-14 days. The presentation of GBS pneumonia typically occurs within the first 24-48 hours of life with respiratory distress, lethargy, and poor feeding, as noted in the revised guidelines from the CDC in 2010 1. According to these guidelines, infants with early-onset GBS disease generally present with respiratory distress, apnea, or other signs of sepsis within the first 24–48 hours of life. The most common clinical syndromes of early-onset disease are sepsis and pneumonia; less frequently, early-onset infections can lead to meningitis.

The algorithm for secondary prevention of early-onset GBS disease among newborns, as outlined in the 2010 CDC guidelines 1, suggests that antibiotic therapy should be directed toward the most common causes of neonatal sepsis, including intravenous ampicillin for GBS and coverage for other organisms. This approach is crucial because GBS pneumonia can rapidly progress to sepsis, which has a significant mortality rate even with appropriate treatment.

Key considerations in the management of GBS pneumonia in neonates include:

• Immediate initiation of intravenous antibiotics after obtaining necessary cultures
• Supportive care with oxygen therapy, ventilatory support if needed, and close monitoring of vital signs
• Prevention strategies such as intrapartum antibiotic prophylaxis for GBS-positive mothers
• Recognition that the infection develops when the neonate is exposed to GBS during delivery from a colonized mother, highlighting the importance of maternal screening and prophylaxis.

Given the potential for severe outcomes, including sepsis and mortality, prompt recognition and treatment of GBS pneumonia in neonates are critical, and guidelines such as those provided by the CDC in 2010 1 offer a framework for managing this condition effectively.

From the Research

GBS Neonate Pneumonia

• Group B Streptococcus (GBS) is a common cause of neonatal early-onset sepsis and pneumonia among term infants, and a major cause of late-onset sepsis among both term and preterm infants 2.
• The primary risk factor for neonatal GBS early-onset disease is maternal colonization of the genitourinary and gastrointestinal tracts, with approximately 50% of women who are colonized with GBS transmitting the bacteria to their newborns 3.
• Intrapartum antibiotic prophylaxis is the primary recommended approach to prevent perinatal GBS disease, with penicillin, ampicillin, or cefazolin recommended for prophylaxis 2, 3.
• Empiric antibiotics are recommended for infants at high risk for GBS early-onset disease, and the American Academy of Pediatrics recommends evaluating newborns for all causes of early-onset sepsis, including GBS pneumonia 2, 4.
• There is no effective approach for the prevention of GBS late-onset disease, including pneumonia 2, 4.
• Ampicillin is frequently used in neonates for early- and late-onset GBS disease, including pneumonia, but the dosing recommendations should be used with caution due to the risk of supratherapeutic concentrations and seizures 5.

Diagnosis and Treatment

• The diagnosis of GBS pneumonia in neonates typically involves clinical evaluation and laboratory tests, including blood and cerebrospinal fluid cultures 4.
• The treatment of GBS pneumonia in neonates typically involves empiric antibiotics, with ampicillin and penicillin commonly used 2, 4, 5.
• The dosing recommendations for ampicillin in neonates with GBS pneumonia should be based on the latest guidelines and literature, taking into account the risk of supratherapeutic concentrations and seizures 5.

Prevention

• The prevention of GBS pneumonia in neonates involves universal antenatal microbiologic-based testing for the detection of maternal GBS colonization, and the administration of intrapartum antibiotic prophylaxis to women who are colonized with GBS 2, 3, 4.
• The American College of Obstetricians and Gynecologists recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation, and administering intrapartum antibiotic prophylaxis to women who are positive for GBS 3.