2025 – PAGE 91 – OB/GYN AND SOME STDs

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

GESTATIONAL DIABETES MELLITUS

Unlike regular DM, gestational diabetes mellitus is NOT associated with congenital anomalies.

SERUM ALPHA-FETOPROTEIN (AFP) SCREEN

A serum alpha-fetoprotein (AFP) screening is offered at 16 weeks gestation. If the AFP is elevated (more than twice the normal limit), there is likely some type of defect in which the baby’s skin is broken. This is usually a neural tube defect.

• ­If the AFP is elevated, get a fetal ultrasound.
• ­If the ultrasound is negative, obtain an amniocentesisto get amniotic AFP levels.
• ­Elevated AFP is also seen in gastroschisis (broken skin!), other abdominal wall defects, fetal demise, renal anomalies, wrong dates, and wrong number of kids (twins).
• ­LOW SERUM AFP is associated with DOWN syndrome.
  • MNEMONIC: “LOW kind of means DOWN”