From the Guidelines
Group B Streptococcus (GBS) infections in newborns are a leading cause of neonatal morbidity and mortality, and can be prevented through universal antenatal GBS screening and intrapartum antibiotic prophylaxis for culture-positive and high-risk women. The incidence of early-onset GBS disease in neonates has decreased by an estimated 80% since the implementation of these prevention strategies 1. GBS disease occurs when the bacteria are transmitted from the mother to the infant during labor and delivery, and can cause serious infections such as sepsis, pneumonia, and meningitis.
Key Points
- The principal risk factor for early-onset invasive GBS disease is maternal colonization with GBS in the genitourinary or gastrointestinal tract 1.
- Women who are identified as being GBS-colonized through culture-based screening are more than 25 times more likely to deliver an infant with early-onset infection than are women with negative prenatal cultures 1.
- The Centers for Disease Control and Prevention (CDC) recommends universal antenatal GBS screening at 35-37 weeks' gestation and intrapartum antibiotic prophylaxis for culture-positive and high-risk women 1.
- The American Academy of Pediatrics (AAP) endorses these guidelines and recommends that newborns whose mothers receive intrapartum antibiotic prophylaxis for GBS disease be monitored for signs of infection 1.
Prevention Strategies
- Universal antenatal GBS screening at 35-37 weeks' gestation
- Intrapartum antibiotic prophylaxis for culture-positive and high-risk women
- Monitoring of newborns for signs of infection
- Education of prenatal patients regarding GBS disease and the available prevention policy 1
Important Considerations
- GBS disease can have serious consequences for newborns, including sepsis, pneumonia, and meningitis.
- Prevention strategies have been shown to be effective in reducing the incidence of early-onset GBS disease.
- Regular follow-up with a pediatrician is essential to monitor for signs of infection and to ensure that newborns receive appropriate care.
From the Research
Definition and Cause of Group B Streptococcus (GBS) Infections
- Group B Streptococcus (GBS) infection is a leading cause of neonatal complications, particularly sepsis and meningitis 2, 3, 4, 5, 6.
- GBS is a type of bacteria that can be present in the vagina and rectum of pregnant women, and can be transmitted to the newborn during delivery 3, 4, 5.
- The risk of GBS infection in newborns increases in cases of preterm delivery, maternal fever during delivery, and membrane rupture more than 18 hours before delivery 4.
Prevention and Treatment of GBS Infections
- Intrapartum antibiotic prophylaxis (IAP) is the most effective strategy for preventing GBS infection in newborns, and is recommended for all GBS-positive pregnant women 2, 3, 4, 5, 6.
- The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of IAP 6.
- Penicillin G is the preferred antibiotic for IAP, with ampicillin as an alternative, and should be administered at least four hours before delivery for maximum effectiveness 3, 5.
- For women allergic to penicillin, clindamycin, erythromycin, or vancomycin may be used as alternatives 3, 4, 5.
Diagnosis and Management of GBS Infections in Newborns
- Asymptomatic neonates born to GBS-colonized mothers should be observed for at least 24 hours for signs of sepsis 5.
- Newborns who appear septic should have a diagnostic work-up, including blood culture, followed by initiation of ampicillin and gentamicin 5.
- The management of infants at risk for GBS disease should be guided by current recommendations, including the use of IAP and the evaluation of newborn infants at risk for GBS disease 6.