Updated RCOG Group B Strep Guidelines by Group B Strep Support

Updated RCOG Group B Strep Guidelines Key points for health professionals summarised by Group B Strep Support

www.gbss.org.uk

Helpline: 0330 120 0796 Office No: 0330 120 0795

Updated RCOG 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 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 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.

1 . Hughes RG, Brocklehurst P, Steer PJ, Heath P, Stenson BM on behalf of the Royal College of Obstetricians and *\QDHFRORJLVWV 3UHYHQWLRQ RI HDUO\ RQVHW QHRQDWDO JURXS % VWUHSWRFRFFDO GLVHDVH *UHHQ WRS *XLGHOLQH 1R %-2* '2,

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1. What should you do during a woman’s pregnancy? 1. What should you do during a woman’s pregnancy?

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leaflet has been produced jointly by the RCOG and B Strep Support and is available for OHDIOHW KDV EHHQ SURGXFHG MRLQWO\ E\ WKH 5&2* DQG Group *URXS % 6WUHS 6XSSRUW DQG LV DYDLODEOH IRU GRZQORDG LQ (QJOLVK DQG DGGLWLRQDO ODQJXDJHV SOXV DV KDUG FRSLHV IRU IDPLOLHV DQG WKH 1+6 IURP download in English and14 additional languages, plus as hard copies for families and the NHS from GRZQORDG LQ (QJOLVK DQG DGGLWLRQDO ODQJXDJHV SOXV DV KDUG FRSLHV IRU IDPLOLHV DQG WKH 1+6 IURP *%66 6HH KWWSV JEVV RUJ XN SURIHVVLRQDO UHVRXUFHV IUHH UHVRXUFHV JEV LQIRUPDWLRQ LQ \RXU RZQ GBSS. See https://gbss.org.uk/professional-resourcesfree-rsources/gbs-information-in-your-ownlanguage/ *%66 6HH KWWSV JEVV RUJ XN SURIHVVLRQDO UHVRXUFHV IUHH UHVRXUFHV JEV LQIRUPDWLRQ LQ \RXU RZQ ODQJXDJH ODQJXDJH If a woman has had a GBS urinary tract infection (>I05 cfulml) during her pregnancy, treat her at diagnosis with ,I D ZRPDQ KDV KDG D *%6 XULQDU\ WUDFW LQIHFWLRQ ! FIX PO GXULQJ KHU SUHJQDQF\ WUHDW KHU DW GLDJQRVLV oral antibiotics, and make sure also to offer her IV antibiotics in labour (GTG 6.1). ZLWK RUDO DQWLELRWLFV DQG PDNH VXUH DOVR WR RIIHU KHU ,9 DQWLELRWLFV LQ ODERXU *7* ,I D ZRPDQ KDV KDG D *%6 XULQDU\ WUDFW LQIHFWLRQ ! FIX PO GXULQJ KHU SUHJQDQF\ WUHDW KHU DW GLDJQRVLV ZLWK RUDO DQWLELRWLFV DQG PDNH VXUH DOVR WR RIIHU KHU ,9 DQWLELRWLFV LQ ODERXU *7* Treating GBS found on a vaginal or rectal swab is not recommended in pregnancy before labour starts. 7UHDWLQJ *%6 IRXQG RQ D YDJLQDO RU UHFWDO VZDE LV QRW UHFRPPHQGHG LQ SUHJQDQF\ EHIRUH ODERXU VWDUWV The woman should be offered IV antibiotics when labour starts (GTG 6.2). 7UHDWLQJ *%6 IRXQG RQ D YDJLQDO RU UHFWDO VZDE LV QRW UHFRPPHQGHG LQ SUHJQDQF\ EHIRUH ODERXU VWDUWV 7KH ZRPDQ VKRXOG EH RIIHUHG ,9 DQWLELRWLFV ZKHQ ODERXU VWDUWV *7*

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2. Who should be offered antibiotics in labour? 2. Who should be offered antibiotics in labour? Women should be offered antibiotics effective against GBS in labour who: Women should be offered antibioticsRU DOWHUQDWLYHO\ RIIHUHG WHVWLQJ VHH EHORZ effective against GBS in labour who: *7* • FDUULHG *%6 LQ D SUHYLRXV SUHJQDQF\

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3. When is an offer of antenatal testing appropriate? 3. When is an offer of antenatal testing appropriate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ÀFDOO\ VWDWH ¶WHVW IRU *%6· RQ WKH UHTXHVW IRUP *7* YDJLQD DQG UHFWXP *7* ZLWK VDPSOHV FXOWXUHG XVLQJ HQULFKHG FXOWXUH PHGLD DQG SURFHVVHG $6$3 *7* <RX VKRXOG VSHFLÀFDOO\ VWDWH ¶WHVW IRU *%6·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

The full Green-top guideline is free to download from: ZZZ UFRJ RUJ XN he full Green-top guideline is free to download from: www.rcog.org.uk/ TJXLGDQFH EURZVH DOO JXLGDQFH JUHHQ WRS JXLGHOLQHV SUHYHQWLRQ RI HDUO\ RQVHW guidance/browse-all-guidance/green-top-guidelines/prevention-of-earlyJURXS E VWUHSWRFRFFDO GLVHDVH JUHHQ WRS JXLGHOLQH QR onset-group-b-streptococcal-disease-green-top-guideline-no-36/

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: www.rcog.org.uk/ guidance/browse-all-guidance/green-top-guidelines/prevention-of-early-onsetgroup-b-streptococcal-disease-green-top-guideline-no-36/

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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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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8. What do I do next? • 'RZQORDG WKH 5&2*·V *UHHQ WRS *XLGHOLQH IURP www.rcog.org.uk/guidance/browse-all-guidance/ green-top-guidelines/prevention-of-early-onset-group-b-streptococcal-disease-green-top-guidelineno-36/

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• Download the RCOG GBSS patient information leaflet in English and 14 other languages from gbss.org.uk/professional-resources/free-resources/gbs-information-in-your-own-language/

• If women who want to test for GBS carriage during pregnancy are unable to access an ECM test in your Trust, signpost them to ZZZ JEVV RUJ XN WHVW IRU VXSSOLHUV WKDW IROORZ 3+(·V 8. 60, % &RVW IURP around IRU KRPH WHVWLQJ SDFN DQG UHSRUWLQJ

• If families in your care want more information about group B Strep, please suggest they contact our +HOSOLQH RQ 0330 120 0796

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.

Search Group B Strep Support

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0330 120 0795

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