Clinical features:
(1) late onset (1 week to months after birth)
(2) apnea, lethargy, bradycardia, decreased feeding, etc
(3) positive cultures for Group B Streptococcus
Risk factors:
(1) premature or small for gestational age infant
(2) history of mastitis or obstructed ducts in the mother
(3) improper collection or storage of breast milk
(4) positive maternal pre-delivery screen for Group B Streptococcus
Late onset Group B Streptococcal sepsis can occur even if all risk factors are absent, so it is important to culture the breast milk.
Recommendations:
(1) Culture the infant and mother.
(2) Culture the breast milk.
(3) Discontinue feeding with maternal breast milk until culture results are known. Consider use of banked breast milk if available.
(4) Treat the infant with empiric antibiotics, with adjustments based on clinical and laboratory findings.
Recurrent infection can occur, so it is important to continue to monitor the infant.
