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Audit of Current Practice in Preventing Early Onset Neonatal Group B Streptococcal Disease in the UK

We are writing to Medical Directors and Directors of Nursing and Midwifery to draw your attention to the findings of second report of the RCOG audit of the current practice in preventing early onset Group B Streptococcal (EOGBS) disease in the UK.

The Report was published on 29 January and can be found here. 

The Report found a worrying variation across the country between local protocols and the above national guidelines. This is a concern and the Report makes a number of recommendations including:

  • National guidelines should be applied to all NHS trusts to reduce future deviations in local practice and policy. Local protocols should be reviewed at least every 3 years to ensure they are fit for purpose and that they reflect current national guidance. The last review date should be recorded on the current protocol and the recording of the last review date should be moni-tored in national audits.
  • Admission criteria and practice in midwife-led units should be informed by national guidelines on preventing EOGBS, including the availability of GBS-specific IV antibiotics.

Reducing morbidity and mortality in neonates is a goal that we all strive for. GBS is the most common cause of severe infection in babies during the first 3 months of life and EOGBS, although rare, has a mortality rate of 5 – 10% and relatively little is known about its long term effects.
Current national guidance is set out in the RCOG’s Green-top Guideline No. 36 - The Prevention of Early-onset Neonatal Group B Streptococcal Disease. A scheduled review of this guideline is currently underway.

Clearly, we are considering how the national guidelines can be further improved; taking into account the recommendations of the Second Report. While this work is ongoing, the current national guidelines are the most appropriate means of preventing EOGBS. Therefore, we would ask that you ensure the national guidelines, reflecting the views of the Royal College of Obstetricians and Gynaecologists, are implemented effectively and consistently across the NHS.

We strongly encourage all maternity services to review and update their local protocols against the current national guidelines to ensure that they follow best practice, and that any update to the guidance is taken into account and incorporated.

Yours faithfully,

Professor Dame Sally Davies, Chief Medical Officer, England
Mr David Richmond PRCOG MD, President Royal College of Obstetricians and Gynaecologists
Dr Matthew Jolly MBBS MD MRCOG, National Clinical Director for Maternity Review and Women’s Health