From the Guidelines
Pediatric Group B Streptococcal (GBS) disease should be prevented through proper prenatal screening and intrapartum antibiotic prophylaxis, as it is the leading infectious cause of morbidity and mortality among infants in the United States. According to the revised guidelines from the CDC in 2010 1, the incidence of GBS has declined dramatically over the past 15 years, from 1.7 cases per 1,000 live births to 0.34–0.37 cases per 1,000 live births in recent years.
Key Points
- Infants with early-onset GBS disease generally present with respiratory distress, apnea, or other signs of sepsis within the first 24–48 hours of life 1.
- The most common clinical syndromes of early-onset disease are sepsis and pneumonia; less frequently, early-onset infections can lead to meningitis 1.
- The case-fatality ratio of early-onset disease has declined from as high as 50% in the 1970s to 4%–6% in recent years, primarily because of advances in neonatal care 1.
- Mortality is higher among preterm infants, with case-fatality rates of approximately 20% and as high as 30% among those ≤33 weeks’ gestation, compared with 2%–3% among full-term infants 1.
Prevention and Management
- Early-onset infections are acquired vertically through exposure to GBS from the vagina of a colonized woman 1.
- Neonatal infection occurs primarily when GBS ascends from the vagina to the amniotic fluid after onset of labor or rupture of membranes, although GBS also can invade through intact membranes 1.
- Proper prenatal screening and intrapartum antibiotic prophylaxis can help prevent GBS disease in newborns 1.
From the Research
Pediatric Guillain-Barré Syndrome
- Guillain-Barré Syndrome (GBS) is an acute, paralysing, inflammatory peripheral nerve disease that can affect children 2.
- The diagnosis of GBS in children is based on clinical criteria, and supported by cerebrospinal fluid (CSF) and electrophysiological findings 3.
- Treatment options for pediatric GBS include intravenous immunoglobulin (IVIg) and plasmapheresis, with IVIg being recommended for severe or persistently-progressive cases 3.
Treatment Efficacy
- Studies have shown that IVIg can hasten recovery in children with GBS, with low-quality evidence suggesting that it is effective in reducing the duration of the illness 2, 3.
- Plasmapheresis is also an effective treatment for GBS, but its use is often limited by its availability and potential side effects 2, 3.
- Corticosteroids are not effective in treating GBS, but may be considered in cases where acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected 3, 4, 5.
Comparison of Treatment Options
- A study comparing IVIg and plasmapheresis found that both treatments were equally effective in hastening recovery, with no significant difference in outcomes between the two groups 2.
- Another study found that adding IVIg to plasmapheresis did not confer significant extra benefit, but the results were not conclusive due to the small sample size 2.
- The use of other pharmacological agents, such as interferon beta-1a and brain-derived neurotrophic factor, has been studied, but the evidence is limited and of very low quality 4, 5.