AAP updates recommendations for infants at risk for group beta strep

  • Pediatrics

  • International Clinical Digest
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  • The American Academy of Pediatrics (AAP) has updated its recommendations for management of newborns at risk for group beta strep disease (GBS).

Why this matters

  • Recommendations accompany publication of updated guidelines from the American College of Obstetricians and Gynecologists (ACOG) for screening and management for GBS in pregnancy .
  • About 20%-30% of US pregnant people are carriers of GBS.
  • Experts note that long-term health effects of perinatal antibiotic exposure are not fully known. 

Key recommendations

  • As ACOG does, the AAP supports universal screening and antibiotic prophylaxis against maternal-infant transmission, where indicated.
  • For neonates, intrapartum penicillin (or other antibiotic, as indicated) offers sufficient prophylaxis against early-onset GBS.
  • Risk assessment for early-onset GBS in infants includes stratifying by ≥35 0/7 weeks of gestation vs those born earlier.
  • Diagnosis of early-onset GBS should involve blood or cerebrospinal fluid culture because other nonspecific lab tests are not adequate.
  • Evaluation for late-onset GBS should rely on clinical signs and GBS isolate in blood, cerebrospinal fluid, other typical sterile tissues.
  • Antibiotic therapy should be empiric but varies by age at evaluation.
  • Includes algorithm for evaluation: red flags include preterm labor, prelabor rupture of membranes (ROM), induced labor with infection concern or neonate respiratory/cardiovascular instability, indicated cesarean delivery with ROM.

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