Volume 31 • Number 12 • December 2010
CDC updates guidelines on
prevention of perinatal GBS
Standing orders for healthy
newborns are valid,
say CMS, Joint Commission
by Carrie L. Byington, M.D., FAAP, and
Carol J. Baker, M.D., FAAP
• clarification of adequate IAP; and
• a revised algorithm for the management of newborns
(see figure on page 12).
The CDC initially published guidelines for the prevention of perinatal GBS disease in 1996 and revised
the guidelines in 2002. Following publication and implementation of the first guidelines, early-onset GBS disease
in neonates has declined by an estimated 80%. However,
GBS remains the leading cause of early-onset neonatal
sepsis. The new guidelines are based on an evaluation
and synthesis of research generated after 2002.
In the 2010 guidelines, the indications for maternal
IAP remain unchanged from 2002 and include: 1) GBS
positive at 35-37 weeks’ gestation, 2) GBS status
unknown with one or more risk factors (less than 37
weeks’ gestation, ROM for 18 or more hours or intrapartum temperature of 100.4 degrees Fahrenheit or
higher [ 38 degrees Celsius]), 3) GBS bacteriuria during
current pregnancy, or 4) history of a previous infant
with GBS disease.
by Sheryl Cash • Correspondent
The Centers for Disease Control and Prevention
(CDC) has revised its guidelines for the prevention of
perinatal group B streptococcal (GBS) disease (MMWR.
2010;59 [No. RR- 10]), www.cdc.gov/mmwr/preview/
The 2010 guidelines, which have been endorsed by
the Academy, reaffirm the major prevention strategy —
universal antenatal GBS screening and intrapartum
antibiotic prophylaxis (IAP) for GBS-positive women.
The guidelines also include:
• new recommendations for laboratory methods to
identify GBS colonization during pregnancy;
• algorithms for screening and intrapartum prophylaxis for women with preterm labor or premature
rupture of membranes (ROM);
• updated prophylaxis recommendations for women
with a penicillin allergy;
See GBS, page 12
Digesting the data
As probiotic and prebiotic products fly off the shelves, a new
clinical report reviews usage, benefits and the need for more research
by Alyson Sulaski Wyckoff
Probiotics and prebiotics
are added to a variety of
foods, beverages and nutritional supplements marketed to children and adolescents. Does
the research support their widespread use?
A new AAP clinical report Probiotics and
Prebiotics in Pediatrics, published in the
December issue of Pediatrics (2010;126:
1211-1225), reviews the medical uses of
probiotics and prebiotics. It also summarizes
what is known about their health benefits
as dietary supplements. In most cases, the
report says, further evidence-based research
is needed before routine recommendations
can be made for their use in pediatrics.
Turn to page 8 for a Q&A with report
co-authors Dan W. Thomas, M.D., FAAP,
and Frank R. Greer, M.D., FAAP.
See Probiotics, page 8
Pediatricians soon may get a good night’s sleep.
A new letter from the Centers for Medicare
& Medicaid Services (CMS) confirms that hospital standing orders for healthy newborns —
including the administration of hepatitis vaccine,
vitamin K and prophylactic ophthalmic antibiotics — are indeed valid, and that physicians no
longer will need to provide round-the-clock
approval to initiate such care.
Despite the traditional practice of hospitals
providing standard newborn care based on a
physician’s preapproved standing orders, the
misinterpretation of a federal directive several
years ago caused many hospitals to require staff
to document immediate direct communication
with physicians before commencing care.
An October 2008 CMS memo confirmed the
validity of preapproved standing orders for
healthy newborns (see December 2008 AAP
News). However, many hospital administrators, fearing citations and lost accredita- tion, continued to deny that these orders were legal and
proper. The Joint Commission supported the
As a result, the “inhumane” calls to pediatri-
cians at all hours continued, said AAP Past Pres-
ident David T. Tayloe Jr., M.D., FAAP, who has
led the effort to clarify this issue.
“It was an interesting saga and a ridiculous
interpretation (of the CMS directives) that had
a widespread effect on Academy members,” said
After another two years of meetings and correspondence among the Academy, CMS and
The Joint Commission — and with the assistance
of Robert Hall, J.D., assistant director, AAP
Department of Federal Affairs — Dr. Tayloe
See Standing orders, page 4
In this issue
The use of probiotics and prebiotics as food additives and nutritional
supplements is widespread even though there is a lack of evidence
showing any health benefits, according to a new AAP clinical report.
The Affordable Care Act, children and you
Learn of AAP efforts to ensure the provision requiring insurers to cover preventive services is implemented in ways
that increase access to care and avoid unintended consequences for pediatricians. Page 9
2011 CPT coding changes
A comprehensive list of pediatric additions and revisions.