Management of asymptomatic term neonates whose mothers received intrapartum antibiotics .2. Diagnostic tests and management strategies

The evaluation of the potentially septic newborn is often a source of frustration for practitioners. In the past, it has often been standard practice to evaluate and treat empirically all neonates whose mothers received antibiotics during labor, regardless of whether the infant had any signs or symptoms suggestive of infection, With the advent of recommendations for intrapartum antibiotic therapy to prevent early-onset neonatal group B streptococcal infections, this strategy is no longer practicable because too many infants would thus be evaluated and treated needlessly This two-part review addresses the issues involved in managing-asymptomatic newborns whose mothers received intrapartum antibiotics. Part I, published separately reviewed the rationale behind strategies for preventing intrapartum transmission of bacterial infection. This final part addresses the evaluation and management of the newborn. A number of diagnostic tests are often used in looking for bacterial infections in the neonate. Unfortunately none of these is both rapid and reliable, A clinical pathway provided here can serve as a useful guide for the clinician, but uncertainty will always remain. Ultimately, each practitioner must determine the degree of risk or uncertainty that he or she can accept on the basis of clinical experience.