I read the excellent article "Update on Group B Streptococcal Infections" in the July/September 2008 issue regarding the continued impact this infection is having on newborns in the United States.1 As a mother/baby nurse in a high-risk community hospital, this is an extremely important topic. Having access to the most up-to-date research will assist in preventing many unnecessary infant deaths. It was interesting to note that with the 1996 guidelines there was a significant decrease of infected infants and a further decrease in 2002 when the national guidelines were released.1

The article further details what the recommendations are regarding GBS (Group B streptococcal)-exposed infants.1 This is where as nurses we seem to be perplexed. The nurse must first determine what, if any, intrapartum antibiotic prophylaxis (IAP) treatment the mother received. There are 5 different possibilities of how she may have been treated for the infection, and these are clearly broken down in this article.1 Once this is established, the nurse must determine from a second chart, which includes an additional 5 separate categories, which must be analyzed to proceed with what needs to be done for the infant. The actions taken at this time pertain to such criteria as time of IAP treatment, gestational age, and what, if any, physical symptoms the infant is presenting.1

Reading through the criteria and actions, we understand the reasoning for what steps must be taken to ensure a healthy infant outcome. With approximately 15% to 45% of all pregnant women carrying GBS sometime during their pregnancy, this becomes an issue of tremendous concern in the term nursery.1 As shown in the article, it is of vital importance to follow these steps to prevent GBS infection in the infant.1 With this in mind on a typical day, the nursery I work in admits at least 10 to 12 infants. Of these, based on statistics at least 3 or 4 infants admitted may fall into the GBS screening population. These infants will then need to be evaluated, on the basis of the charts what the plan of care will be. This can be an enormous burden on the admitting nurse to properly assess where this infant stands in regards to the GBS risk. If there is a delay in drawing blood cultures, discharging infants is delayed until results are evaluated, usually at least 48 hours. This then affects bonding issues as the infant must remain in the hospital for close observation, as well as financial issues for the extended stay.

It is at this stage that working in a term nursery becomes more involved. At the very least these infants require frequent vital signs and close observation by staff.1 The author of the article states that the nurses should always have a high level of suspicion that these infants may develop sepsis.1 There are many criteria that the nurse needs to look for such as poor feeding, respiratory distress, apnea, lethargy, to name a few. Nurses were not always attuned to these specific issues with the newborn before reading this information. If this alerts even one nurse who would not have realized the significance of her findings previously, this information would have made a difference in the lives of many.

There are other obstacles as reported by one study sponsored by the Centers for Disease Control and Prevention (CDC) relating to the GBS guidelines. They discovered that an area needing improvement was in the clinical laboratory. In several states up to 61% of the laboratories were using the wrong media to process the cultures.2 This could lead to erroneous results being reported. In another CDC-sponsored review, only 52% of deliveries had documented GBS screenings.2 With so much at stake regarding the infant's health, the CDC has developed an initiative to reduce infant morbidity and mortality due to GBS infection.1-3 They are requesting that healthcare worker, hospitals, clinical laboratory personnel, state and local public health partners, and the public raise awareness as to the seriousness of this infection.3 The CDC has even gone as far as developing an active group B strep prevention team located in the respiratory diseases branch of the Division of Bacterial Diseases in the National Center for Immunization and Respiratory Diseases.3

As nurses, we need to continue to read important articles such as these to ensure that we are staying current and applying the latest findings in our daily practice to reduce the stumbling blocks in the road to a healthy infant. Although the diagnosis and treatment of these infants may appear complex with familiarity, it will soon become second nature. Together we need to join with the CDC and promote awareness of this life-threatening condition to eliminate infant deaths due to this infection.

Sherry Durden, BSN, RNC

Assistant Nurse Manager, Mother/Baby Unit, Broward Health-Broward General Medical Center, Ft Lauderdale, FL 33334

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