798 DECREASED MORTALITY IN EARLY ONSET GROUP B STREPTOCOCCAL (GBS) SEPSIS: FACTORS THAT RELATE TO SURVIVAL

Abstract

We have observed a low mortality (12.5%) in a total of 16 infants in our nursery with early onset GBS sepsis (positive blood culture during the first days of life). The following factors did not correlate to survival: maturity, birth weight, Apgar score, manner of delivery and duration of rupture of membranes (ROM). The single factor that related to the infant's survival was the onset of treatment with antibiotics. None of the infants treated early (<12 hours of age) died, whereas 2/6 (33%) of the infants treated late (>12 hours of age) died. Early treatment was initiated because of one or a combination of the following conditions: 1) respiratory distress soon after birth, 2) PROM (>12 hours) and/or 3) gastric aspirate positive for gram-positive cocci. The 2 infants who died were premature and had respiratory distress at birth, initially diagnosed as HMD. Antibiotics were not started until 16-24 hours later. Of the 4 infants who received late treatment but survived, 2 were fullterm and 2 were premature. The latter had no respiratory distress but problems of apnea or jaundice on the 3rd or 4th day which prompted a sepsis work-up.

CONCLUSION: Although no significant statistical analysis can be drawn from this small sample, we feel that the following generalizations can be offered: 1) GBS sepsis can occur without PROM. The shortest duration of ROM in our series = 10 minutes, 2) the early treatment of GBS sepsis has been the single most important factor in our increased survival rate. A high index of suspicion is therefore necessary. In general, any infant with respiratory distress soon after birth should have a gastric aspirate smear, and if positive for gram positive cocci, should be treated with antibiotics until culture results become known. Factors such as gestational age, birth weight, Apgar score, PROM and white cell count, should not influence the decision to withhold therapy.

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