**9. Indication of prophylaxis usage of antibiotics during delivery**

GBS bacteruria during pregnancy; Previous child with GBS infection; Mother's temperature greater than 38°С, even when GBS culture is negative; Unknown GBS status and early discharge of amniotic fluid >18 hr., gestational age less than 37 weeks, mother's temperature is greater than 38°С. [2]

#### **Antenatal Prophylaxis**

10 Neonatal Bacterial Infection

**Skin:** 

 Mottling Cold or wet Cyanosis Jaundice [12]

 Metabolic Acidosis Tachycardia

Pale or marble with petechia or purple

**8. Evaluations criteria of neonatal sepsis** 

urine by using catheter or suprapubic puncture. [13]

laboratory Indexes with obvious abnormality.[13]

screening tests and/or bacterial investigation.

**Evaluation Criteria of Late Sepsis** 

thrombocytopenia

Symptoms of sepsis and any of the following symptoms;

**Lumbar Puncture (LP):** When should *a lumbar puncture be conducted?*

Bacterial inoculation of blood; Leukocytes (<5 or >30х109/l); Total number of neutrophils; Leukocyte index (LI) >0,2; CRP >10 mg/l (Initial examination no later than 12 hours from birth); ESR > 15 mm/hr; Chest X-ray in the presence of Respiratory Distress Syndrome (RDS); Lumbar puncture in the presence of neurological symptoms; Bacterial inoculation of

Bulging of fontanel, any neurological symptoms, leukocytes < 5 or > 30 х 109 in 24 hours or > 20 х 109 since second 24 hours or Leukocyte Index (LI) > 0,4 or CRP > 40 mg/l or> 2,

Common clinical conditions if sepsis is suspected; Instability of body temperature; Gastrointestinal symptoms (vomiting, abdominal distension, blood in stool, increase in quantity of residual mass in stomach); Neurological symptoms; Cardiorespiratory dysfunction (100<HR> 180, 30<BR > 60, hypotension, time of capillary filling > 4 sec); Respiratory symptoms (toughening of parameters of lungs mechanical ventilation of BR > 60, apnoea); Metabolic acidosis; hyperglycemia/hypoglycemia; Leukocytosis; leukopenia; Ratio of immature neutrophils compared to the total number of neutrophils (LI)>2,0 ,

**Treatment should starts in case of possible sepsis if;**the mother is suspected of having infection; the infant has clinical signs of infection; the infant has possible signs of infection in combination with low weight at birth, asphyxia and other risk factors; positive results of

GBS bacteruria during pregnancy; Previous child with GBS infection; Mother's temperature greater than 38°С, even when GBS culture is negative; Unknown GBS status and early

**9. Indication of prophylaxis usage of antibiotics during delivery** 

It is important to use a wide variety of laboratory methods for identification of GBS (Group B streptococcus). Defining the number of colonies in urine of pregnant women is necessary to diagnose GBS.[2]

Main changes in the 2010 guidelines include the following: Intranatal Prophylaxis - Change of penicillin-G recommended dose for chemoprophylaxis; Updating schemes of prophylaxis for women with an allergy to penicillin and revising the algorithms. [2]

**Secondary Prophylaxis of GBS in Case of Early Sepsis of Neonates** 

**Figure 5.** Prevention of Perinatal Group B Streptococcal Disease Revised Guidelines from CDC, 2010 [11]

Full diagnostic evaluation includes a blood culture, a complete blood count (CBC) including white blood cell differential and platelet counts, chest radiograph (if respiratory abnormalities are present), and lumbar puncture (if patient is stable enough to tolerate procedure and sepsis is suspected).Antibiotic therapy should be directed toward the most common causes of neonatal sepsis, including intravenous ampicillin for GBS and coverage for other organisms (including Escherichia coli and other gram-negative pathogens) and should take into account local antibiotic resistance patterns. Consultation with obstetric providers is important to determine the level of clinical suspicion for chorioamnionitis. Chorioamnionitis is diagnosed clinically and some of the signs are nonspecific. Limited evaluation includes blood culture (at birth) and CBC with differential and platelets (at birth and/or at 6–12 hours of life). If signs of sepsis develop, a full diagnostic evaluation should be conducted and antibiotic therapy initiated. If 37 weeks' gestation, observation may occur at home after 24 hours if other discharge criteria have been met, access to medical care is readily available and a person who is able to comply fully with instructions for home observation will be present. If any of these conditions are not met, the infant should be observed in the hospital for at least 48 hours and until discharge criteria are achieved. Some experts recommend a CBC with differential and platelets at age 6–12 hours. [11]
