Recently there have been some real steps forward towards reducing group B Strep (GBS) infections in newborn babies. In September, the Royal College of Obstetricians & Gynaecologists (RCOG) published their updated clinical guideline on preventing early-onset group B Strep infection(i). This includes some major changes from past editions, summarised below.
Group B Strep infections in babies are relatively rare but – when they happen – can be devastating. Group B Strep is the most common cause of life-threatening infection in newborn babies. Typical presentations are sepsis, meningitis and pneumonia.
The key time to be aware of group B Strep is the first 12 hours after birth, as that’s when most of these infections in babies develop(ii). By the time a baby’s three months old, group B Strep infections are very rare.
Most babies sick with group B Strep infection will make a full recovery. But even with treatment, at least one in every 20 of these very sick babies die. One in every 10 of the survivors suffers long-term disability.
We already know how to prevent the majority of early-onset group B Strep infections – intravenous antibiotics given in labour to women carrying group B Strep reduces the incidence by over 80%(iii). Most developed countries offer testing for group B Strep carriage to all women late in pregnancy, with intravenous antibiotics offered in labour to women who test positive, and have seen their rates fall. The UK has used a risk-based strategy since 2003, where women are offered intravenous antibiotics offered in labour if certain risk factors are present. Despite this, the UK rate has been rising, not falling(iv).
The RCOG’s updated group B Strep guideline has 29 new recommendations. It also includes a useful flowchart to help navigate the key recommendations for when women should – and shouldn’t – be offered intravenous antibiotics in labour.
Midwives are such an important source of information and advice for pregnant women. They will play a vital role in implementing these new guidelines, for the benefit of both the Mum and her baby.
Key recommendations in the guideline are (new recommendations in bold):
- All pregnant women are provided with an information leaflet on group B Strep (new)
- Women who carried group B Strep in a previous pregnancy should be offered the option of: sensitive (ECM) testing for group B Strep late in the current pregnancy with intravenous antibiotics in labour if positive; or intravenous antibiotics in labour without testing (new)
- Women are offered intravenous antibiotics in labour where:
o A previous baby developed group B Strep infection
o group B Strep has been detected during the current pregnancy
o group B Strep was detected in a previous pregnancy and the baby was healthy, and Mum has not had a negative ECM test in the current pregnancy (new)
o Mum is in established preterm labour (before 37 weeks of pregnancy), whether group B Strep has been detected or not (new)
o Mum has a fever in labour of 38 or higher
- If testing for group B Strep carriage, do so within the last 5 weeks of pregnancy (usually 35 to 37 weeks gestation), with samples taken from the low vagina and rectum. Mark the samples for testing for group B Strep carriage, and process them using an enrichment culture medium. (new)
- Women who have a group B Strep urinary tract infection during pregnancy should receive appropriate treatment at the time of diagnosis, as well as intravenous antibiotics in labour. Antibiotics before labour are not recommended if group B Strep is found from vaginal or rectal swabs.
A recent Bounty survey of over 3000 women who were pregnant or their youngest child was under 2 reported that nearly half of new and expectant Mums consider midwives as a key source of information about group B Strep (48%). Midwives are key to their decision making about group B Strep during pregnancy (98% stating very or fairly important).
Group B Strep Support provides information materials to NHS Trusts and health professionals working in the NHS without charge.
Group B Strep Support (GBSS) and the RCOG are working together to produce a joint patient information leaflet on group B Strep, available for 2018. GBSS is also producing a summary of the RCOG’s 2017 guideline, highlighting the changes.
i. Hughes RG, Brocklehurst P, Steer PJ, Heath P, Stenson BM on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention of early-onset neonatal group B streptococcal disease. Green-top Guideline No. 36. BJOG 2017; DOI: 10.1111/1471-0528.14821
ii. National Institute of Health Care and Excellence. Neonatal Infection (Early Onset): Antibiotics for Prevention and Treatment. NICE clinical guideline 149. London: NICE, 2012.
iii. Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: Experience in the United States and implications for a potential group B streptococcal vaccine. Schrag SJ, Verani JR. Vaccine. 2012 Dec 3. pii: S0264-410X(12)01697-0
iv. Group B streptococcal disease in infants . Heath P. BPSU Annual Report 2015-2016. (2016). London: British Paediatric Surveillance Unit, pp.10-12.
Jane Plumb MBE is Chief Executive of Group B Strep Support