Prevention of Early Onset Neonatal Group B Streptococcal Disease
The purpose of this document is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal group B streptococcal (GBS) disease.
Group B streptococcus (Streptococcus agalactiae) is recognised as the most frequent cause of severe earlyonset (less than 7 days of age) infection in newborn infants. However, there is still controversy about its prevention. A survey in 2001 demonstrated that less than 1% of UK maternity units were performing systematic screening for GBS1 and, so far, UK clinicians have not generally adopted guidelines from the USA,Australia and Canada that encourage screening. The Public Health Laboratory Service Group B Streptococcal Working Group has produced interim guidelines4 but these are based on US data (in the absence of available UK data) and have not been widely adopted in this country. The US Centers for Disease Control and Prevention (CDC) now recommend that all pregnant women undergo bacteriological screening, with vaginal and rectal swabs taken for GBS culture at 35–37 weeks of gestation. Extrapolation of practice from the USA to the UK may be inappropriate. The incidence of early-onset GBS disease in the UK in the absence of systematic screening or widespread intrapartum antibiotic prophylaxis is 0.5/1000 births, which is similar to that seen in the USA after universal screening and intrapartum antibiotic prophylaxis, despite comparable vaginal carriage rates. In 2001, a national UK surveillance study identified 376 cases of early-onset GBS disease, 39 of which were fatal. There were 2519 neonatal deaths from all causes in the UK in 2000. The incidence of early-onset disease in the USA has fallen in association with the introduction of screening pregnant women for GBS. The current US guidelines advise that all women colonised with GBS at 35–37 weeks (or labouring before this time) should be offered intrapartum antibiotic prophylaxis, usually in the form of high-dose intravenous penicillin or ampicillin. Intrapartum antibiotic prophylaxis has been shown to significantly reduce the risk of early-onset but not late-onset disease (occurring seven or more days after birth).Antenatal screening and treatment have not yet demonstrated an effect on all cause neonatal mortality and may carry disadvantages for the mother and baby. These include potentially fatal anaphylaxis, the medicalisation of labour and the neonatal period, and infection with resistant organisms.
The full guideline and a summary of the recommendations can be downloaded as pdfs using the links below.
- Prevention of Early Onset Neonatal Group B Streptococcal Disease (full guideline)
- Prevention of Early Onset Neonatal Group B Streptococcal Disease (summary of recommendations)
RCOG Audit on the prevention of neonatal Group B Streptoccocal disease
A report of this audit can be downloaded here.
