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Circulatory Paper

1048 words - 5 pages

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Guidelines for Prevention of Neonatal Group B Streptococcal Infection

Purpose of Policy:

Intrapartum antibiotic prophylaxis (IAP) to prevent neonatal Group B Streptococcal (GBS) disease has reduced the incidence of invasive early-onset GBS infections in newborns by 70%. The revised 2002 CDC guidelines for the prevention of GBS disease are based upon universal screening for GBS in all pregnant women.

Scope of Policy:
Nurses, LIP with OB privileges, residents

Policy/guideline:

I. Screening:

Screen every (see exceptions*) pregnant woman for GBS with vaginal and rectal culture at 35-37 weeks gestation. If the pt is PCN allergic, request sensitivities on ...view middle of the document...

*● Give IAP when diagnosis of preterm labor is made at <37 wks and continue until delivery or until labor is arrested and tocolytic therapy is discontinued.
● PPROM > 34.0 weeks: Deliver. Give IAP unless GBS culture was negative
● PPROM <34.0 weeks :
a) If laboring and + GBS/unknown GBS treat with appropriate regimen below
b) If not laboring and GBS known/unknown: latency ATBs (total = 7 days)
1) Amp 2 g IVPB then 1 g IVPB Q 6 X 48 hours and
Erythro 250 mg IVPB Q 6 X 48 hours then
2) Amoxicillin 250 mg Q 8 X 5 days and
Erythro 333 mg Q 8 X 5 days
c) Obtain GBS culture results and treat accordingly when labor begins. If culture is negative and labor occurs > 5 weeks from result, re-screen patient

III. Intrapartum Prophylaxis NOT Indicated:

• Current pregnancy is documented to be GBS negative even if previous pregnancy screened GBS positive.
• Planned cesarean delivery performed in the absence of labor or membrane rupture (regardless of maternal GBS culture status).
• Negative vaginal and rectal GBS screening culture in late gestation during the current pregnancy, regardless of intrapartum risk factors.

IV. Regimens for IAP prophylaxis:

1. PCN G, 5 million units IV initial dose, then 2.5 million
units IV every 4 hours until delivery.

2. If PCN allergic AND NOT at high risk for anaphylaxis: Cefazolin, 2g
IV initial dose, then 1g IV every 8 hours until delivery.

3. If PCN allergic AND at high risk for anaphylaxis,
GBS susceptible to both Clindamycin and Erythromycin:
Clindamycin, 900 mg IV every 8 hours until delivery
(Use of Erthromycin no longer recommended even if sensitive)

4. If PCN allergic AND at high risk for anaphylaxis, GBS sensitivities unknown,
OR GBS resistant to either Clindamycin or Erythromycin:
Vancomycin, 1 g IV every 12 hours until delivery

V. Initiation of IAP Prophylaxis:
1. Antibiotics for IAP should be entered by the provider with admission
orders.
2. IAP antibiotics will be started by the nurse when:
a. regular CTXs established (Q 5 min or less)
b. ROM at any point in the labor process
c. as otherwise ordered in PCOSS (e.g. Start IAP on admission
for Hx rapid labor)

...

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