What is GBS?
Group B streptococcus (GBS) is a common type of the streptococcus bacterium. Approximately a third of men and women 'carry' GBS in their intestines and a quarter of women carry it in their vagina. Most of us are unaware it's there, as GBS carried in this way can be difficult to detect and doesn't cause problems or symptoms. GBS is one of a number of different bacteria that normally live in our bodies and carrying it is perfectly normal. Once GBS has 'colonised' the intestines, no antibiotics tested so far can reliably eradicate it.What should I know about GBS?
Although GBS is the most common cause of bacterial infection in newborn babies in the UK, this happens relatively rarely. Around one in 1,000 babies in the UK develops a GBS infection, which is about 700 babies a year.
Babies are usually exposed to GBS shortly before or during birth. This happens to thousands of babies with no ill effects: just why some babies are susceptible to the bacteria and develop infection while others don't is not clear. What is clear is that most GBS infection in newborn babies can be prevented by giving women in high-risk situations antibiotics intravenously (through a vein) from the onset of labour or waters breaking until the baby is born.
Oral antibiotics given prior to delivery have not been shown to be effective at preventing GBS infections in babies. Nor are Caesareans recommended to prevent GBS infection in babies since GBS infections can still occur in babies born by Caesarean section:
- There are significant risks associated with a Caesarean section
- The recommended intravenous antibiotics during labour are highly effective
- Very occasionally GBS causes infection of the 'waters', womb or urinary tract in mothers of newborn babies
Who is most at risk of GBS infection?
There are seven situations where a baby is more likely to be exposed to GBS and, if susceptible, to develop GBS infection. Giving pregnant women in the seven situations listed below intravenous antibiotics at regular intervals from the start of labour or waters breaking through to delivery has been shown to be effective in stopping most GBS infection in newborn babies.
RISK FACTORS FOR GBS INFECTION IN NEWBORN BABIES:
Clinical risk factors (each increases the risk at least three times):
- Labour is preterm (before 37 completed weeks of pregnancy)
- There is premature rupture of membranes (before 37 completed weeks of pregnancy) with or without other signs of labour
- There is prolonged rupture of membranes (more than 18 to 24 hours before delivery) with or without other signs of labour
- The pregnant woman has a raised temperature (37.8?C or higher) during labour
Mothers who carry GBS during the present pregnancy (multiplies the risk at least four times): - The pregnant woman has been found to carry GBS during the present pregnancy
- The pregnant woman has GBS bacteria in her urine at any time during the present pregnancy
(this should be treated at the time of diagnosis)
Mothers who have previously had a baby infected with GBS (multiplies the risk about ten times):- The pregnant woman has had a baby who developed a GBS infection
How can most GBS infection in babies be prevented?
The risk factors listed above identify most babies who will benefit from their mothers receiving intravenous antibiotics and, if the mother is known to carry GBS, will reduce the risk of her baby developing GBS infection from around one in 300 to less than one in 6,000.
Key recommendations:
- Women at increased risk should be offered antibiotics immediately at the onset of labour through to delivery (i.e. women known to carry GBS without other risk factors and women not known to carry GBS but where another risk factor is present).
- Women at particularly high risk should be strongly advised to accept intravenous antibiotics immediately at the onset of labour through to delivery (i.e. women known to carry GBS with one or more other risk factors, women not known to carry GBS with multiple risk factors and women who have previously had a baby infected with GBS).
- For women in labour, the recommended doses of penicillin G are 3 g (or 5 MU) intravenously initially and then 1.5 g (or 2.5 MU) at four-hourly intervals until delivery (for women allergic to penicillin, clindamycin, 900 mg intravenously every eight hours until delivery, is recommended).
- Intravenous antibiotics should be given for at least four hours prior to delivery where possible.
- Babies born in situations where there is increased risk and the mother has received at least four hours of intravenous antibiotics prior to delivery should be assessed carefully by a paediatrician and, if completely healthy, intravenous antibiotics should not be given to the baby.
- Babies born in situations where there is increased risk and the mother has not received at least four hours of intravenous antibiotics prior to delivery should be investigated fully and initially commenced on antibiotics until it is established the baby is not infected.
There are small but serious risks associated with taking antibiotics, so the decision must be considered carefully.
Having and using the information provided here significantly reduces the likelihood of your baby developing GBS infection. Pregnancy can normally be managed so that babies born to women who carry GBS are protected and born free from GBS.
GBS infection in babies
In the unlikely event you need information about GBS infection in babies, approximately 60 per cent of these infections in babies are apparent at birth and 90 per cent are apparent within the baby's first two days ('early-onset' GBS infection), so they should be detected and treated in hospital.
Aggressive intravenous antibiotic therapy successfully treats most babies who develop GBS infection but, even with the best medical care, sadly 10-20 per cent of these sick babies die (typically from septicaemia, pneumonia or meningitis) and some suffer long?term problems.
Signs of GBS infection in newborn babies
Typical signs of 'early-onset' GBS infection (developing in the baby's first two days of life) include:
- Grunting
- Poor feeding
- Lethargy
- Low blood pressure
- Irritability
- High/low temperature
- High/low heart rates
- High/low breathing rates
NB: Grunting, poor feeding and lethargy are common and generally harmless symptoms in many new born babies, however parents should monitor the situation and contact a GP if they are in any doubt.Around 10-20% of GBS infection develops after the baby is two days old ('late-onset' GBS infection), usually as meningitis with septicaemia. Sadly, about 5-10 per cent of babies who develop late-onset GBS infection die and approximately a third suffer long-term problems.
The warning signs of 'late-onset' GBS infection, including meningitis, may include one or more of:
- Fever
- Poor feeding and/or vomiting
- Impaired consciousness
- Shrill or moaning cry or whimpering
- Dislike of being handled, fretful
- Tense or bulging fontanelle (soft spot on head)
- Involuntary body stiffening/jerking movements
- Floppy body
- Blank, staring or trance-like expression
- Altered breathing patterns
- Turns away from bright lights
- Pale and/or blotchy skin
If your baby shows signs consistent with late-onset GBS infection or meningitis, call your GP immediately. If your GP isn't available, go straight to your nearest casualty department. If your baby has late-onset GBS infection or meningitis, early diagnosis and treatment are vital: delay could be fatal.
What else do I need to know?
The GBS bacteria may be passed from the hands so everyone (including the parents), whether they know they carry GBS or not, should wash their hands properly and carefully dry them before handling a baby for its first three months of life. The risk to a baby of developing GBS infection decreases with age - GBS infection in babies is rare after one month of age and virtually unknown after three months.
Can I find out if I carry GBS?
You may not be able to find out for sure, as no really reliable test is routinely available in the UK - they miss up to 50 per cent of GBS carriers. And if you get a positive result, all it tells you is that you carried GBS at the time the culture was taken, not that you will necessarily still carry GBS at delivery (though you probably will). What you can do is make sure you know when it's more likely a baby will develop GBS infection, how most GBS infection can be prevented, and what signs of GBS infection to watch for in your baby.
What should I do next?
You should discuss GBS with your midwife and obstetrician and agree a pregnancy and birth plan that includes what should happen about GBS. Proven methods exist which stop most GBS infection from developing in newborn babies. In the vast majority of cases, pregnancy can be managed so the babies of women who carry GBS are protected - and are born healthy and free from GBS.
For more information about GBS, please speak with your medical professionalsand/or contact:
Group B Strep Support
Preventing GBS infection in newborn babies
P O Box 203
Haywards Heath
West Sussex
RH16 1GF
Tel: 0870 803 0023
Fax: 0870 803 0024
Visit: www.gbss.org.uk
Email:info@gbss.org.uk