AAP updates recommendations for infants at risk for group beta strep

Takeaway

• 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.