Group B Streptococcus - The most common cause of life-threatening infection in newborns in the UK

This article is designed to raise the awareness of a bacteria present in many pregnant women which is capable of causing infection in newborn babies, yet can be easily detected and the majority of infections easily prevented. During my first pregnancy, it was found by chance, that I was a

Group B Streptococcus (also known as Beta Strep, Beta Haemolytic Strep, Strep B and streptococcus agalactiae) is the most common cause of life-threatening infections in newborn babies in the UK, yet the profile of this usually harmless bacteria is relatively low. Up to a third of all men and women carry GBS in their intestines without any symptoms, and roughly one quarter of all women of child-bearing age carry GBS in their vaginas at any one time. GBS is a bacteria that is carried quite normally in the body without any harmful effects, but can be transmitted to the baby during birth. The danger to the baby is still relatively low, however preventative medicine can improve the outcomes:- 700 babies born in the UK each year become infected with GBS, and of these, 75 or more die, with 40 survivors left with long term problems. To put this in to perspective, around 700,000 babies are born in the UK annually.

GBS infection will usually (80% of the time) show up within two days, and the remaining infections are usually evident within the first three months of life. Factors that a pregnant women can be aware that make them more at risk are:

• Where the labour or membrane rupture is prior to 37 weeks of pregnancy
• Where the membranes have ruptured more than 18-24 hours before delivery.

In the UK, the NHS may happen to test for GBS. I was found to be a carrier when swabs were taken following a slight bleed during the early part of my third trimester. I was stunned to discover that the NHS test results are reliable when a positive result is received, but with a negative result to the test given, 50% of the time this is inaccurate. There is, however, a test that the pregnant women can arrange through their GP at a cost of only £32. Two swabs will need to be taken - one from the rectum, one the vagina, and these will be sent off for analysis. Although no one would relish the idea of this, let's face it  childbirth is not the most dignified of acts, and a babies life could be safeguarded.

If GBS is detected, the mother would need to be given intravenous antibiotics for 4 hours during labour for the baby to be covered. This is believed to prevent 60% of infections. Should labour be shorter than this, the baby would be given intravenous antibiotics for a period so that any risk of infection is negated. In my experiences, my first labour was sufficiently long (and some!) yet my son arrived after just 3 1/2 hours and so he required intravenous antibiotics twice a day for three days before it was agreed that the risk was minimal.

Once a women is found to be a carrier, this does not mean that either they or the baby will become ill, but that there is a risk to the baby. A GBS carrier is likely to remain a carrier for all subsequent pregnancies. Antibiotics taken during the pregnancy are unlikely to remove the bacteria completely, and they are likely to recolonise the intestines.

Symptoms that you could detect in a newborn baby with early onset GBS infection include:

• grunting;
• lethargy;
• irritability;
• poor feeding;
• very high or low heart rate;
• abnormal (high or low) temperature; and
• abnormal (fast or slow) breathing rates with blueness of the skin due to lack of oxygen.

Typical symptoms of late-onset GBS infection are

• fever;
• poor feeding and/or vomiting; and
• impaired consciousness.

Typical symptoms of meningitis in babies, including GBS meningitis (any of these could develop but some may not be present at all) include:

• fever, which may include the hands and feet feeling cold, and/or diarrhoea;
• refusing feeds or vomiting;
• shrill or moaning cry or whimpering;
• dislike of being handled, fretful;
• tense or bulging fontanelle (soft spot on the head);
• involuntary body stiffening or jerking movements;
• floppy body;
• blank, staring or trance-like expression;
• abnormally drowsy, difficult to wake or withdrawn;
• altered breathing patterns;
• turns away from bright lights; and
• pale and/or blotchy skin.

If a baby shows signs consistent with late-onset GBS infection or meningitis, call your doctor immediately. If your doctor isn't available, go straight to your nearest Casualty Department. If a baby has late-onset GBS infection or meningitis, early diagnosis and treatment are vital: delay could be fatal.

For more information about the testing process and symptoms of infection in newborn babies, please check http://www.gbss.org.uk/