2025 – PAGE 174 – NEONATOLOGY

Managing Newborns

After the delivery, pediatricians must decide if a baby will need diagnostic evaluation, antibiotics and how long the baby should be observed in the hospital. A full diagnostic evaluation includes CBC, blood culture, chest x-ray (if there are any abnormal respiratory signs) and lumbar puncture (if the procedure can be tolerated). Limited diagnostic evaluation includes a CBC and blood culture. If antibiotics are started, baby should be monitored for 48 hours. If there were never any signs of sepsis, stop antibiotics after 48 hours. For a neonate born to a mom for whom IAP was indicated (or the GBS status was not known), the information below should help you decide how to treat the baby:

• FULL DIAGNOSTIC EVALUATION + ANTIBIOTIC THERAPY (FULL COURSE): If appropriate IAP was given, then do this anytime the baby HAS SIGNS SEPSIS. Baby will stay for the full course of antibiotics.
• LIMITED DIAGNOSTIC EVALUATION + ANTIBIOTIC THERAPY: If appropriate IAP was given, then do this if mom had chorioamnionitis and the baby has NO SIGNS OF SEPSIS. Discharge at 48 hours if the baby appears well.
• LIMITED DIAGNOSTIC EVALUATION + NO ANTIBIOTIC THERAPY: If the baby is doing well (NO signs of sepsis), but mom DID NOT receive adequate IAP, then do a limited workup if there was PROM (> 18 hours) OR if gestation was < 37 weeks. Discharge at 48 hours if the baby appears well.
• OBSERVE FOR 48 HOURS (SCENARIO 1): If the gestation was > 37 weeks with ROM occurring < 18 hours prior to delivery, and if the baby is doing well (NO signs of sepsis), but mom DID NOT receive adequate IAP, then no diagnostic workup is needed, and you can simply observe for 48 hours.
• OBSERVE FOR 48 HOURS (SCENARIO 2): Regardless of gestational age, if appropriate IAP was given and the baby is well (no signs of sepsis), you can simply observe for 48 hours.

Treating Newborns with GBS Disease

In general, ampicillin and gentamicin are good empiric treatments when GBS is suspected but not confirmed. If meningitis is suspected, add on an expanded-spectrum cephalosporin (eg, cefotaxime, ceftazidime, or cefepime). If the culture results are known, the definitive treatment is penicillin G since GBS is uniformly sensitive to penicillin and ampicillin. For specific antibiotic regimens in situations where culture results are not yet available, empiric treatment is based on the site of the infection and whether the infection is early onset” (birth to DOL 6) or late onset (DOL 6+):

• EARLY ONSET
  • Bacteremia, sepsis or pneumonia: ampicillin IV + gentamicin IV
  • Meningitis: ampicillin + gentamicin + cefotaxime
• LATE ONSET
  • Bacteremia: ampicillin (or vancomycin) + gentamicin (or cefotaxime)
  • Meningitis: ampicillin (or vancomycin) + gentamicin + cefotaxime
  • Cellulitis/adenitis: nafcillin (or vancomycin) + gentamicin (or cefotaxime)
  • UTI: ampicillin (or vancomycin) + gentamicin (or cefotaxime)
  • Septic arthritis or osteomyelitis: nafcillin (or vancomycin) + cefotaxime