Updated Group B Strep Guidelines Key points for health professionals compiled by Group B Strep Support
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Updated Group B Strep Guidelines Key points for health professionals Group B Streptococcus (GBS or group B Strep) is the most common cause of severe infection in newborn babies, and of meningitis in babies under age 3 months. On average in the UK: • 2 babies a day develop group B Strep infection • 1 baby a week dies from group B Strep infection • 1 baby a week survives group B Strep infection with long term disability 0RVW *%6 LQIHFWLRQ LV RI HDUO\ RQVHW SUHVHQWLQJ LQ EDELHV ZLWKLQ WKH ÀUVW GD\V RI OLIH DQG XVXDOO\ ZLWKLQ WKH ÀUVW KRXUV DIWHU ELUWK %HWZHHQ DJH days and 3 months, these infections are rare, and in babies over after age 3 months they are very rare indeed. 0RVW HDUO\ RQVHW *%6 LQIHFWLRQV LQ EDELHV DJHG GD\V FDQ EH prevented by giving intravenous antibiotics in labour to women whose babies are at raised risk of developing GBS infection. In the UK, women DUH RIIHUHG ,9 DQWLELRWLFV LQ ODERXU LV EDVHG RQ VSHFLÀF ULVN IDFWRUV The Royal College of Obstetricians and Gynaecologists (RCOG) published a major update to their clinical guideline on preventing group B Strep LQIHFWLRQ WKHLU *UHHQ WRS *XLGHOLQH *7* 1R 1 RQ 6HSWHPEHU There are substantial changes from the previous edition, published in DQG WKLV OHDÁHW VXPPDULVHV WKH NH\ UHFRPPHQGDWLRQV New recommendations are in italics, and the GTG paragraph numbers are given in brackets.
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1. What should you do during a woman’s pregnancy? • 3URYLGH DOO SUHJQDQW ZRPHQ ZLWK D SDWLHQW LQIRUPDWLRQ OHDÁHW DERXW JURXS % 6WUHS *7* $ VXLWDEOH OHDÁHW
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• Treating GBS found on a vaginal or rectal swab is not recommended in pregnancy before labour starts. 7KH ZRPDQ VKRXOG EH RIIHUHG ,9 DQWLELRWLFV ZKHQ ODERXU VWDUWV *7*
2. Who should be offered antibiotics in labour? Women should be offered antibiotics effective against GBS in labour who:
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3. When is an offer of antenatal testing appropriate? ,I D ZRPDQ FDUULHG *%6 LQ D SUHYLRXV SUHJQDQF\ DQG WKH EDE\ GLG QRW GHYHORS *%6 GLVHDVH DQ (QULFKHG &XOWXUH 0HGLXP (&0 VZDE WHVW IRU *%6 FDUULDJH DW ZHHNV RU HDUOLHU LI SUHWHUP GHOLYHU\ LV DQWLFLSDWHG VKRXOG EH RIIHUHG *7* 7KH (&0 WHVW LV QRW WKH VDPH DV D VWDQGDUG VZDE IRU D YDJLQDO GLVFKDUJH 6ZDEV VKRXOG EH WDNHQ ERWK IURP WKH ORZ YDJLQD DQG UHFWXP *7* ZLWK VDPSOHV FXOWXUHG XVLQJ HQULFKHG FXOWXUH PHGLD DQG SURFHVVHG $6$3 *7* <RX VKRXOG VSHFLÀFDOO\ VWDWH ¶WHVW IRU *%6· RQ WKH UHTXHVW IRUP *7* ,I SRVLWLYH WKH ZRPDQ VKRXOG EH RIIHUHG DQWLELRWLFV LQ ODERXU ,I QHJDWLYH VKH FDQ EH UHDVVXUHG WKDW WKH ULVN RI HDUO\ RQVHW QHRQDWDO *%6 GLVHDVH LV YHU\ ORZ DERXW LQ ,I VKH GHFOLQHV WKH WHVW VKH VKRXOG EH RIIHUHG DQWLELRWLFV LQ ODERXU *7*
The full Green-top guideline is free to download from: ZZZ UFRJ RUJ XN HQ JXLGHOLQHV UHVHDUFK VHUYLFHV JXLGHOLQHV JWJ
Key recommendations from Royal College of Obstetricians & Gynaecologists’ 2017 Prevention of Early-onset Neonatal Group B Streptococcal (GBS) Disease Green-top Guideline No 36
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IAP = Intrapartum Antimicrobial Prophylaxis Benzyl Penicillin recommended. If penicillin-allergic, a cephalosporin. If severely allergic, vancomycin. Clindamycin not recommended. Offer ASAP once labour has started. BABY WITH SIGN(S) OF EOGBS INFECTION
NICE CG149, point 1.2.3.1: TREAT BABY WITH 3(1,&,//,1 $1' GENTAMICIN WITHIN AN HOUR OF '(&,6,21 72 75($7
“If there are any risk factors for early-onset neonatal infection or if there are clinical indicators of possible early-onset neonatal infection perform a careful clinical assessment without delay. Review the maternal and neonatal history and carry out a physical examination of the baby including an assessment of vital signs.”
The full Green-top guideline is free to download from: ZZZ UFRJ RUJ XN HQ JXLGHOLQHV UHVHDUFK VHUYLFHV JXLGHOLQHV JWJ
4. Which IV antibiotic should I use? If the woman has agreed to have the IV antibiotics in labour, they should be given as soon as possible once ODERXU KDV VWDUWHG DQG DW UHJXODU LQWHUYDOV XQWLO WKH EDE\ LV ERUQ *7*
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Get the facts and get involved at: www.gbss.org.uk
6. After the baby is born: • ,I D ZRPDQ FDUU\LQJ *%6 GHFOLQHG ,9 DQWLELRWLFV LQ ODERXU KHU EDE\ VKRXOG EH PRQLWRUHG YHU\ FORVHO\ IRU KRXUV DIWHU ELUWK DQG 0XP VKRXOG EH GLVFRXUDJHG IURP YHU\ HDUO\ GLVFKDUJH *7*
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7. Signs of GBS infection to look out for in a newborn baby: )DPLOLHV VKRXOG EH HQFRXUDJHG WR VHHN XUJHQW PHGLFDO DWWHQWLRQ LI WKHLU EDE\ *7*
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The full Green-top guideline is free to download from: ZZZ UFRJ RUJ XN HQ JXLGHOLQHV UHVHDUFK VHUYLFHV JXLGHOLQHV JWJ
8. What do I do next? • 'RZQORDG WKH 5&2*·V *UHHQ WRS *XLGHOLQH IURP
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Sources and acknowledgements 7KH LQIRUPDWLRQ LQ WKLV OHDÁHW LV EDVHG RQ 5&2* *UHHQ²WRS *XLGHOLQH 1R Prevention of Early-onset Neonatal Group B 6WUHSWRFRFFDO 'LVHDVH
Charity Group B Strep Support was founded in 1996, with the over-arching objective of preventing group B Strep infection in newborn babies. We support families affected by group B Strep, educate health professionals and the public about group B Strep, and support research into better understanding of group B Strep infection.
Get the facts and get involved at: Search Group B Strep Support
www.gbss.org.uk
7HO #GBSaware
0330 120 0796
www.gbss.org.uk
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