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Group B Strep - What You Should Know

Author: Neil Fearn  Bullet  Dated: 10/07/2015

July is Group B Strep (GBS) awareness month, a GBS infection can be life threatening and have a devastating effect with long term physical disabilities for those babies that survive. Only half of new and expectant mums are aware of GBS. Therefore it is the aim of the charity Group B Strep Support not only to raise awareness of GBS, but to prevent unnecessary infection, disability and mortality in new born babies, after all, prevention is better than cure.

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GBS is a 'bug' that lives inside the digestive system and in the vagina and it is usually harmless but it can be transferred to a baby during labour when a baby passes through the birth canal.

There are 2 main types of Group B Strep Disease:

  • 1. Early-onset disease - this occurs during the first week of life. Most babies who become infected develop symptoms within 12 hours of birth
  • 2. Late-onset disease - this occurs from the first week through three months of life.

GBS is recognised as the most frequent cause of life-threatening infection in new born babies, causing septicaemia (infection of the blood), pneumonia (infection in the lungs) and meningitis (infection in the protective membranes that surround the brain and spinal cord). Meningitis is more common with late-onset group B strep disease than with early-onset group B strep disease.

It must be stressed that just because you may be a carrier of GBS during labour and delivery does not necessarily mean that you or your baby will become ill; only a relatively small number of babies born to women who have GBS at delivery will actually develop GBS infection. Women, whose babies are identified as being at increased risk of GBS infection, are given intravenous antibiotics, as soon as possible once labour has started and 4 hourly thereafter until delivery. The Royal College of Obstetricians and Gynaecologists (RCOG) recommends that the first dose should be given at least 2 hours before delivery and of those babies affected, most will go on to make a successful recovery.

A significant problem is that there is no screening policy for GBS in the UK. The UK National Screening Committee has not recommended that universal screening for GBS be introduced into practice because in their view there is no clear evidence that antenatal screening for GBS carriage does more good than harm. For example there may well be an increase in anaphylaxis, as well as an increase in antibiotic-resistant bugs if antibiotics such as amoxicillin are to be used purely for prophylaxis. Additionally there is also the question of costs and whether the benefits of universal screening would be cost-effective for the NHS.

However, a recent pilot study in Northwick Park Hospital, found that there were no cases of the bacteria spreading to babies of those mothers who were tested and treated with antibiotics in the hospital. The only recorded cases over a 12 month period were those babies whose mothers had not agreed to be tested.

There are a number of risk factors that are known to increase the risk of GBS sepsis:

  • • Premature labour before 37 weeks of pregnancy.
  • • Prolonged rupture of membranes - waters breaking 18 hours or more before the baby is delivered.
  • • Elevated maternal temperature (temperature of 37.8°C or higher during labour).
  • • Previously had a baby infected with GBS.
  • • If Mother known to have carried GBS in her vagina during this current pregnancy.
  • • If GBS has been found in your urine at any time during this pregnancy.

Healthcare professionals use the above risk factors to help manage high risk pregnancies. However, in the study, of the women who tested positive for GBS only half would have been classified as 'at risk' under current guidelines. This is obviously of concern. It is clear that GBS screening of all expectant mothers during routine antenatal appointments can work, and calls have been made for the National Screening Committee to review the current position and to introduce a national screening policy.

As Group B Strep Support's chief executive, Jane Plumb, was quoted saying, the findings of the pilot study 'contradict the party line that the risks of screening every woman outweigh the benefits'.

Symptoms to look out for in early onset GBS

  • • Anxious or stressed appearance
  • • Blue appearance (cyanosis)
  • • Breathing difficulties such as:
    • Flaring of the nostrils
    • Grunting noises
    • Rapid breathing
    • Short periods without breathing
  • • Irregular or abnormal heart rate - may be fast or very slow
  • • Lethargy – very drowsy
  • • Pale appearance (pallor) with cold skin
  • • Poor feeding and low blood sugar
  • • Unstable body temperature (low or high)
  • • Low blood pressure

Although there are no known ways of preventing late-onset group B Strep infection in babies, typical signs are similar to those for early-onset infection but may also include signs associated with meningitis such as:

  • • have a high fever, with cold hands and feet
  • • vomit and refuse to feed
  • • appear agitated and not want to be picked up
  • • become drowsy, floppy and unresponsive
  • • grunt or breathe rapidly
  • • have an unusual high-pitched or moaning cry
  • • have pale, blotchy skin, and a red rash that doesn't fade when a glass is rolled over it (see below)
  • • have a tense, bulging soft spot on their head (fontanelle)
  • • have a stiff neck and dislike bright lights
  • • have convulsions or seizures

Of course, in some instances, GBS may have been identified during the antenatal period but there could have been a failure to act on test results and treat the infection appropriately.

There may even have been a failure to recognise early/late onset GBS resulting in a severe birth injury to your child such as cerebral palsy, brain damage, blindness, hearing loss or another disabling or even fatal outcome, which could have been avoided.

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