17th July 2023
To support Group B Strep Awareness Month 2023, we are sharing this blog by the charity Group B Strep Support on the condition and its impact on young babies.
Jane Plumb MBE FRCOG FRSA, Chief Executive of Group B Strep Support
Group B Strep (GBS) infection in babies is relatively rare, though the consequences can be devastating. It is not uncommon for a health visitor to care only for a handful of families whose babies develop GBS infection during their career. But it is important to be updated about GBS, so you can educate and support families in preventing this silent, yet potentially devastating, infection. Health visitors play a vital role in promoting the health and wellbeing of families, especially during the crucial postnatal period.
Understanding Group B Streptococcus
Group B Strep are bacteria commonly found in a healthy adult’s lower intestines and, in women, the vagina. Approximately one in four pregnant women carry GBS in their rectum or vagina without symptoms and usually without harming the carrier.
GBS can cause severe infections in newborn babies, including pneumonia, sepsis, and meningitis.
Group B Strep in babies:
On average in the UK, approximately:
- 2 babies a day develop GBS infection
- 1 baby a week dies from GBS infection
- 1 baby a week recovers with long-term disability (O’Sullivan et al., 2018)
Around two-thirds of GBS infections in babies present in the first six days of life (described as early-onset GBS infection), mostly in the first 24 hours. Late-onset GBS infections (developing between 7 and 90 days of life) are less common, and infections in older infants are very rare.
Health visitors have a vital role to play in supporting families by providing information on the key signs of GBS infection in babies and what action should be taken if a baby becomes ill.
Prevention is Key
The good news is that appropriate interventions (IV antibiotics during labour) can significantly reduce the risk of early-onset GBS infection in babies. With late-onset GBS infection, early identification of the signs and treatment can save lives, which we will go in to below.
Here are some key points to focus on:
Antenatal Information:
Inform parents about GBS, including the key risk factors that increase the chance of a baby developing GBS infection. Signpost them to information from reputable sources, including Group B Strep Support and the Royal College of Obstetricians & Gynaecologists. The joint RCOG/GBSS patient information leaflet on GBS is available to download here in English and 14 other languages.
Testing for GBS should be offered to a pregnant woman if she carried GBS in a previous pregnancy (RG Hughes et al., 2017). This is a simple swab test in the last five weeks of pregnancy (typically 35-37 weeks) to find out if the mother is carrying GBS. Samples are taken from the low vagina and rectum and then sent to the laboratory for culturing using enrichment techniques (ECM or Enriched Culture Medium testing). ECM testing is not available from all NHS trusts. Signpost here for reputable organisations offering ECM testing privately.
Intrapartum Care:
If GBS has been detected on a maternal vagina or rectal swab or in a urine sample during pregnancy, intrapartum antibiotic prophylaxis (IAP) should be offered as soon as possible once labour starts. The antibiotics are given intravenously from the start of labour and at regular intervals until birth, and significantly reduces the risk of the newborn baby developing GBS infection.
IAP should also be offered in certain other situations, including if the pregnant woman has previously had a baby who developed GBS infection or if she has a fever in labour. IAP is recommended if labour is preterm.
Ensure that parents understand the significance of the risk factors of IAP and are aware of the relevant guidelines.
After birth:
Most babies won’t develop a GBS infection, but it can be catastrophic for those who do.
Educate parents about the signs of GBS infection in babies, such as grunting, fever, difficulty feeding, irritability, and respiratory distress (NICE, 2021). Early-onset GBS infections typically present as sepsis with pneumonia, and signs are usually apparent at or soon after birth. Most early-onset GBS infections can be prevented when IAP is given to pregnant women who are carrying the bacteria in labour (Fairlie, Zell and Schrag, 2013). Most late-onset GBS infections present as sepsis with meningitis and develop between one week and three months after birth. Late-onset GBS infections are not currently preventable, so being aware of the key signs of GBS infection is particularly important, as is seeking urgent medical review should any arise.
Early recognition and prompt medical attention are crucial in preventing severe complications. Signpost to this page for key signs of GBS infection in babies.
Breastfeeding and Hygiene Practices:
Encourage breastfeeding, as it provides essential antibodies to protect newborns from infections, including GBS infections. Emphasise the importance of good hygiene practices, such as regular handwashing, for parents and caregivers.
Supporting Families:
Offer a listening ear, answer any questions, and provide accurate information about the condition. Address any concerns or misconceptions, and ensure they understand the importance of adhering to the recommended preventive measures.
Collaboration and Awareness:
Group B Strep Awareness Month provides an excellent opportunity to collaborate with other healthcare professionals, midwives, and obstetricians to raise awareness about GBS. Organise educational workshops, distribute informative leaflets, and use digital platforms to disseminate accurate and accessible information.
Working together we can empower families and protect newborns from this largely preventable infection.
Conclusion:
Your role in promoting awareness and prevention of GBS infection is invaluable. By educating new and expectant parents, you can help prevent GBS infections, and safeguard the health of young babies. Group B Strep Awareness Month 2023 is an opportunity to make a difference in the lives of families and ensure that every baby has the best start in life.
Jane Plumb MBE FRCOG FRSA , Chief Executive, Group B Strep Support
Key References:
- Fairlie, T., Zell, E.R. and Schrag, S. (2013) ‘Effectiveness of Intrapartum Antibiotic Prophylaxis for Prevention of Early-Onset Group B Streptococcal Disease’, Obstetrics & Gynecology, 121(3), pp. 570–577. Available at: https://doi.org/10.1097/AOG.0b013e318280d4f6.
- Hughes, RG et al. (2017) ‘Prevention of Early-onset Neonatal Group B Streptococcal Disease: Green-top Guideline No. 36’, BJOG: An International Journal of Obstetrics and Gynaecology, 124(12), pp. e280–e305. Available at: https://doi.org/10.1111/1471-0528.14821.
- NICE (2021) ‘Neonatal infection: antibiotics for prevention and treatment NICE guideline’. National Institute for Health and Care Excellence, p. NICE Guideline No 195. Available at: www.nice.org.uk/guidance/ng195 (Accessed: 11 July 2021).
- O’Sullivan, C.P. et al. (2018) ‘Group B streptococcal disease in UK and Irish infants younger than 90 days , 2014 – 15 : a prospective surveillance study’, The Lancet Infectious Diseases, 3099(18), pp. 1–8. Available at: https://doi.org/10.1016/S1473-3099(18)30555-3.
