Perinatal infection screening and prevention — viva

Stem

The examiner hands you the antenatal and birth summary of a term infant: mother GBS-colonised, one dose of intrapartum penicillin given two hours before an otherwise normal vaginal delivery, membranes ruptured for 18 hours, no maternal fever. ^[1]

Examiner: What is your opening approach to this infant? ^[3]

Strong answer: I would first establish whether the infant is well or unwell, because that single judgement drives everything else. Intrapartum GBS prophylaxis was inadequate — fewer than four hours of antibiotics before delivery — so this infant is at increased risk of early-onset GBS sepsis. If the infant is well and term, I would perform a limited evaluation (blood culture and full blood count at 24 to 48 hours) and observe closely; if there is any sign of sepsis, I would move immediately to a full septic screen and empiric intravenous benzylpenicillin and gentamicin. ^[3]