Approach to evaluating neonates born <35 weeks gestation who are at risk for group B streptococcal infection

GBS: group B Streptococcus; IAP: intrapartum antibiotic prophylaxis; LP: lumbar puncture; CSF: cerebrospinal fluid.
* For details regarding indications for IAP, refer to UpToDate's topic on prevention of GBS in pregnancy.
¶ Adequate GBS IAP is defined as the administration of penicillin G, ampicillin, or cefazolin ≥4 hours before delivery.
Δ If there is a strong clinical suspicion for infection, especially in neonates who are critically ill, it may be appropriate to perform LP and CSF culture in addition to the blood culture before starting empiric antibiotics. However, LP should not be performed if the procedure would compromise the neonate's condition. Antibiotic therapy should not be deferred because of procedure delays.
◊ Empiric antibiotic coverage typically consists of ampicillin plus gentamicin. Refer to separate UpToDate content on treatment of neonatal GBS and neonatal sepsis for additional details.
§ For neonates who do not improve after initial delivery room stabilization and/or those who have severe systemic instability, the administration of empiric antibiotics may be reasonable but is not mandatory.