Group Beta Strep

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Group B Strep

What is Group B Strep?

  • Group B Streptococci (GBS, Streptococcus agalactiae) is a type of normal bacteria that 10 to 30% of healthy people carry in the vagina and/or lower intestine of their bodies.
  • “Colonization of GBS” lots of people carry GBS but are not infected
  • GBScolonization isn’t contagious
  • Rarely, the GBSbacteria can attack the body and cause infection (called GBS disease)

How Does a Baby Get GBS?

  • A baby may be colonized before, during or after birthby coming in contact with GBS bacteria
  • Approximately 50% of babies born to mothers with GBScolonization are colonized. (CDC 2002)
  • Ninety-eight percent of babies colonized will have no symptoms.
  • Two percent of babies colonized will become ill with group B strep disease.
  • It is unknown why some infants develop the disease and others don’t.

How Can GBS Disease Affect My Infant?

  • GBSdisease is the most common cause of sepsis (infection of the blood).
  • GBSdisease is also the most common cause of meningitis (infection of the fluid and lining surrounding the brain).
  • GBSdisease is a frequent cause of newborn pneumonia and respiratory issues.
  • Ten to twenty percent of babies that develop GBSdisease die.
  • Some babies that survive, especially those who develop meningitis may develop long-term medical problems, including: hearing or vision loss, varying degrees of physical and learning disabilities, and cerebral palsy.
  • Prematurebabies are at increased risk for GBS disease and long term complications or death as a result.

Early and Late Onset Group B Strep Disease:

  • Two kinds of GBS
  • Early onset presents within the first week of life.
  • Most early onset GBSdisease babies present with respiratory distress symptoms and are ill within the first few hours of life.
  • Babieswho develop early onset disease may have one or more of the following symptoms: problems with temperature regulation, grunting sounds, fever, seizures, breathing problems, unusual change in behavior, stiffness, or extreme limpness.
  • Late onset GBSdisease can also develop in infants one week to several months of age.
  • Meningitis is more common with late onset GBS
  • A baby with late onset GBSdisease may display the following signs: stiffness, limpness, inconsolable screaming, fever, or refusal to nurse

Screening for Group B Strep Bacteria:

  • Some practitioners culture urine for Group B StrepBacteria at 34 weeks.
  • At 36 weeks a Group B Streptest is offered by culturing the vaginal opening and the rectum.
  • If bacteria grow the woman is colonized (positive); if no bacteria grow, the test is negative.
  • When both lower vaginal and rectal sites are sampled and inoculated into selective broth media, almost 100% of GBScarriers are detected.
  • Colonization can be chronic (40%), intermittent, or transient.
  • Can have a positive culture during the 2nd trimester and test negative at 36 weeks.
  • Four to seven percent of women who had negative cultures late in second trimester will have positive GBSculture at delivery. However, about 33% of women who have positive GBS cultures during the second trimester have negative cultures at delivery. This is why testing is not recommended until 36 weeks.
  • Two obstetricians from Stanford Medical Center designed a culture test in 1999 to detect GBSstatus in one hour. The test is called Strep B OIA. It is performed using a sterile swab with sampling obtained from the lower of the vagina (no rectal culturing is done). Cultures must be processed within 72 hours, results available within one hour (ACDM, 1999, paragraph (par.) 19). This test is also cheaper than most others available on the market (Benitz, Gould, & Druzin, 1999, p. 10).

Using Chlorohexidine to Prevent Transmission of Group B Strep Bacteria:

  • For a family who chooses to have the GBStest done at 36 weeks and tests positive or declines testing.
  • Chlorohexidine – A strong antiseptic solution which is diluted to a very mild .02% solution.
  • It is very cost effective.
  • Much less invasive and fewer adverse reactions.
  • Has been shown to be “as effective as ampicillin in preventing vertical transmission of Group B streptococcus.”
  • Treats for E. coli bacteria which ampicillin does not.
  • Chlorohexidine (Hibiclens ®) is included in your birth kit.
  • Begin rinsing when your labor begins either with contractions or with your bag of waters
  • NO DOUCHING – rinse your inner and outer labia, your perirectal area and your vaginal opening.
  • Rinse every four hours with one T (or the first hash mark on the peri bottle) of chlorhexidine to eight oz of water mixed in peri bottle.
  • Please take your temperature every four hours and document it.

Using Antibiotics to Prevent Transmission of GBS Bacteria:

  • The CDC recommends treating a woman who has tested positive or has not been tested and has “risk factors” with four hours of IV antibiotic therapy during labor.
  • Risk factors include having a premature labor, having your bag of watersbroken longer than 18 hours, or having a previous baby who had Group B Strep disease **Not just a positive GBS test in past pregnancy***
  • There is a question of when to treat using antibiotics.
  • Antibioticscan be given to an infant whose mother carries GBS.
  • More than 60% of infants with GBSdisease are already symptomatic at, or shortly after birth and are at high risk of GBS complications and poor outcome.
  • Effectiveness of oral antibiotics during pregnancy is not established.
  • There is a high rate of re-colonization (67%) by delivery (even when sexual partners are also treated).
  • Penicillin G can be used at a dose of five-million units every six hours. If there is a history of penicillin allergy erythromycin 500 mg every six hours, or clindamycin 900 mg every eight hours should be given intravenously.
  • Ideally antibiotics should be given at least four hours before delivery, to allow enough time for the antibiotics to build up in the unborn baby’s circulation and amniotic fluid.
  • One in 10 chance or lower, of having a mild allergic reaction to penicillin (such as rash) (CDC, 2001, section 7).
  • One in 10,000 chance of developing a severe, life-threatening allergic reaction to penicillin (Ibid).

Using Herbs to try to Change Status of GBS Colonization:

  • No known effectiveness.
  • The theory is attempting to change the GBScolonization late in pregnancy by using herbs.
  • GBStest at 35 weeks then if colonized trying the herbal protocol & re-culturing at 37 weeks.
  • If colonized positive in the 3rd trimester, even if you get a negative test after the first positive test, there is a 67% chance of reoccurrence by birth.

Nothing can prevent all GBS Illnesses

  • One in 25 women who are GBSpositive and have risk factors have an infected child (ACDM, 1999, par. 14).
  • One in 200 women who are GBSpositive but have no risk factors have an infected child (Midwifery Today, 2001, par. 2).
  • One in 1,000 women who are GBSnegative and have risk factors have an infected child (ACDM, 1999, par. 14).
  • Three in 10,000 women who are GBSnegative but have no risk factors have an infected child (Ibid).
  • With intravenous antibiotics given in labor, a GBSpositive woman with no risk factors has a one in 4000 chance of delivering a baby with GBS disease (CDC, 2001, section 7).
  • Maternal treatment with Chlorhexidine or antibiotics decreases the incidence of GBSdisease when risk factors for GBS infection are present at delivery. However, it is estimated that this doesn’t prevent up to 30% of GBS infections and 10% of the fatalities.

How do I Know if My Baby is Sick with GBS?

  • Babies who show signs of a GBS infection after birth must also be treated with antibiotics.
  • Fifty percent of babies with Early Onset GBS disease show signs at birth, like they have to work hard to breathe and might need resuscitation.
  • Many more show signs within the first ½ hour after birth.
  • Ninety percent of early onset GBS disease babies begin to get sick within the first 24 hours.
  • There are other types of infections that can look similar to GBS disease but they should all be checked out!
  • Grunting with inhales and exhales, flaring of the nostrils, retractions of the ribs (where you can see the spaces in between), bluing around the mouth and nose. The baby might breathe very fast or very slowly (normal respirations are 40 to 60 breaths per minute). If the baby stops breathing for 15 to 20 seconds, it is another warning sign. With early onset might struggle to keep temperature normal but with late onset might run a fever. The baby might be grayish, washed out, or pale. A sick baby could be blah and lethargic or more irritable with jerkiness and seizures. If something doesn’t seem right with your baby CALL!!

Works Cited:

  • ACDM, (1999). Client Information and Consent for Group B Streptococcal Infections; (2002, March 23).
  • Alkalay, A., (1998). Teaching Files: Group B Streptococcal Infectionin Newborns: Rationale Document for CSMC Clinical Guidelines 94-092-G through 94-096-G (2002, March 23).
  • Benitz, W.E., Gould, J.B., Druzin, M.L., (1999). Preventing Early-Onset Group B Streptococcal Sepsis: Strategy Development Using Decision Analysis; Pediatrics, Volume 103, No. 6, Jun 1999, <https://www.ncbi.nlm.nih.gov/pubmed/10353973> (2002, March 23).
  • CDC (Centers for Disease Controland Prevention), (2001). Group B Streptococcal Disease (GBS). <https://www.cdc.gov/groupbstrep/index.html> (2002, March 23).
  •      Jesse Cause Foundation. Mothers of Babies Killed or Disabled by Preventable Bacteria Travel to CDC Meeting in Georgia to Urge Change in Group B Strep Protocol. <http://www.groupbstrep.com/prcdc.htm> (2002, March 23).
  • Midwifery Today, (1999). Midwifery Today E-news, Volume 1, Issue 28: Group B Strep. <http://www.midwiferytoday.com/enews/enews1n28.asp> (2002, March 23).
  • Midwifery Today, (2001). Midwifery Today E-news, Volume 3, Issue 37: Group B Streptococcus, <http://www.midwiferytoday.com/enews/enews3n37.asp> (2002, March 23).
  • The Society of Obstetricians and Gynaecologists of Canada (SOGC), The Society of Obstetricians and Gynaecologists of Canada Clinical Practice Guidelines: Statement on the Prevention of Early-Onset Group B Streptococcal Infections in the Newborn. Policy statement No.61, June, 1997
  • The Journal of Maternal-Fetal Medicine, 2002, Feb; 11(2):84-8, Chlorhexidine Vaginal Flushing’s Versus Systemic Ampicillin in the Prevention of Vertical Transmission of Neonatal Group B Streptococcus, at Term, Facchinetti F, Piccinini F, Mordini B, Volpe A. Department of Gynecology, Obstetrics and Pediatric Sciences, University of Modena and Reggio Emilia, Modena, Italy
  • International Journal of Antimicrobial Agents, 1999 Aug; 12(3):245-51, VaginalDisinfection with Chlorhexidine During Childbirth,
    Stray-Pedersen B, Bergan T, Hafstad A, Normann E, Grogaard J, Vangdal M. Department of Gynecology and Obstetrics, Aker Hospital, University of Oslo, Norway
  • Lancet, 1992, Sep 26; 340(8822):791; discussion 791-2, Prevention of Excess Neonatal Morbidity Associated with Group B Streptococci by Vaginal Chlorhexidine Disinfection During Labor
  • European Journal of Obstetrics & Gynecology and Reproductive Biology, 1989, Apr; 31(1):47-51, Prevention of Group B Streptococci Transmission During Delivery by Vaginal Application of Chlorhexidine Gel
  • European Journal of Obstetrics & Gynecology and Reproductive Biology, 1985, Apr; 19(4):231-6 Chlorhexidine for Prevention of Neonatal Colonization with Group B Streptococci, III. Effect of Vaginal Washing with Chlorhexidine Before Rupture of the Membranes

To review the new complete guidelines, click here: 2010 Revised Guidelines for Prevention of Perinatal Group B Streptococcal Disease

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