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Late-Onset Group B Strep Meningitis in Neonates: A Case Study Analysis

Explore a case of a 3-week-old girl with fever and fussiness, diagnosed with GBS meningitis. Learn about transmission, symptoms, treatment, prognosis, and prevention strategies for this serious condition. Understand the importance of identifying neonates at risk for serious illness. Fever in neonates can indicate underlying diseases; workup includes CBC, blood and urine culture, LP, and CXR. Use the Rochester Criteria to identify low-risk children and avoid unnecessary antimicrobial treatment.

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Late-Onset Group B Strep Meningitis in Neonates: A Case Study Analysis

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  1. Fever in the Neonate

  2. The Case • 3-week old girl whose mother says she “feels warm” and is “acting fussy” • ???

  3. The History • Irritable, feeding slightly less frequently, sleeping more than usual • 4 days ago had runny nose and cough • Dev: Full-term infant; NSVD; GBS- mother

  4. The Exam • Baby asleep in mother’s arms. When woken up, immediately begins to cry. Mother attempts to feed, but baby is not interested. • Vitals: T: 100.5° | HR 150 | RR 70 | BP 80/50 • All other systems WNL

  5. The Labs Gram Stain: CSF: - WBC 1100, 92%N - Glucose 24 - Protein 190

  6. What Does this Baby Have? Late Onset Group B Strep Meningitis

  7. GBS • A G+ coccus colonizing GU, GI, and respiratory tracts. • Important cause of infection in 3 groups: neonates, pregnant women, non-pregnant adults

  8. GBS in Neonates • Mode of Transmission: • In uterol • Vertical transmission • Late-Onset: colonized household contacts • Classified by age-at-onset into early-onset (through day 6) and late-onset (1w to 3 months)

  9. Early–Onset GBS • Early-Onset (12 hours to 1 week) • Results in bacteremia, sepsis, PNA, meningitis • Generally apparent within 24 hours of birth • Now much less frequent due to preventative measures

  10. Late-Onset GBS • Typically presents with T > 38.0C (100.4F) • May have history of recent URI • Irritability, Lethargy, Poor Feeding, Tachypnea • Associated Conditions: pneumonia, septic arthritis, bacteremia, adenitis, and cellulitis • Less likely to present with severe shock than early-onset GBS patients

  11. The Treatment • Empiric: IV ampicillin + aminoglycoside/3G • Once you are certain of GBS, may switch to Pen G. However higher doses are needed.

  12. Prognosis • About 25% may have hearing loss, vision loss, or learning disabilities • Such outcomes more likely in low birth-weight, delayed treatment, leukopenia

  13. Prevention Strategies • Mechanism of late-onset GBS not known, therefore, prevention is difficult • Much more success with early-onset form • Screen all pregnant women for GBS • Treatment of all high-risk pregnancies during labor

  14. Cause of Neonatal Fever • #1 = Viral (e.g. HSV, Influenza, RSV) • About 7% are bacterial, mostly GBS and G- enterics

  15. Workup of Febrile Neonate • CBC & Blood Culture • UA and Urine Culture • LP • CXR

  16. Rochester Criteria • A systematic approach to identifying low-risk children who may be observed without resorting to antimicrobial treatment • Pediatrics (1994) : 98.9% negative predictive value

  17. Summary – Fever in Neonate • Fever may be the only sign of underlying disease • Must not be neglected – disease may be significant • Defined as T > 100.4º (38.0ºC) • Tactile fever without documented rectal fever may be observed provided that caregiver is reliable

  18. Summary – Fever in Neonate • Main objective is to identify those at risk for serious illness • “Toxic Appearing”: irritability, decreased activity, lethargy – however these are dramatic findings – may not be present • History: Resp/GI symptoms, Sick contacts, Behavioral changes, Urine/Stool changes • Workup: CBC/Cx, UA/Cx, LP, ±CXR

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