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Key to preventing GBS infection in newborn babies is the use of intravenous antibiotics, which has proven to be very effective when given from the start of labour or waters breaking until delivery. Sadly, waiting to give antibiotics to the baby after delivery will sometimes be too late.
The use of any drug, including antibiotics, is not without risk however, so please discuss the antibiotic options with your healthcare professional to make the best decision for you and your baby.
PREVENTION STRATEGY
To stop as many cases of GBS infection in newborn babies as possible, women with any risk factor would need to be given intravenous antibiotics during labour for ideally at least 4 hours before delivery.
Some women will prefer not to receive antibiotics if their risk is only slightly increased since it would inevitably complicate an otherwise natural birth, plus antibiotic therapy is associated with rare but significant complications. The risk of a GBS infection in the baby must be balanced against the wishes and beliefs of the woman in labour and against her risk of an adverse reaction to the antibiotics.
At present, sensitive Enriched Culture Medium tests are not routinely available in the NHS to pregnant women. Until they are, our medical advisory panel has made the following recommendations which are, we believe, the most appropriate for Britain at the present time:
1. Women at risk
Women at high risk should be strongly advised to have intravenous antibiotics immediately at onset of labour until delivery. At high risk means:
- Women who carry GBS and have another risk factor
- Women who may/may not carry GBS, but have multiple risk factors
- Women who have had a previous baby infected with GBS
- Women with a fever during labour
Women at increased risk should be offered intravenous antibiotics immediately at onset of labour through to delivery. At increased risk means:
- Women who are known to carry GBS and do not have other risk factors
- Women who do not know whether they carry GBS but have one other risk factor not mentioned above
2. Treatment approaches
Intravenous antibiotics against GBS infection in the baby should be given to the mother for at least 4 hours before delivery if possible (if only 2 hours is possible, this may be sufficient and should give considerable reassurance)
Intravenous antibiotics recommended for women in labour are:
- Penicillin G: given as 3g (or 5MU) intravenously at first and then 1.5g (or 2.5MU) at 4-hourly intervals until delivery
- For women allergic to penicillin: Clindamycin 900 mg intravenously every 8 hours until delivery
Where infection of the membranes is diagnosed or suspected or where there is preterm prolonged rupture of membranes, broad spectrum intravenous antibiotics should be given which include adequate GBS cover.
If you are allergic to Penicillin or any other antibiotic, you MUST tell your health professionals.
3. Care after birth
With any policy that involves treating certain women with penicillin to prevent GBS infection following rupture of membranes or the start of labour, a strategy for the management of the newborn baby is required.
In all cases, the newborn baby should be assessed as soon as possible by a paediatrician and the threshold for giving antibiotics to babies born in the higher risk situations should be low - see chart here.
Key recommendations are:
Babies born to mothers at increased/high risk who HAVE received antibiotics for four hours before delivery should be:
- carefully assessed by a paediatrician – if completely healthy no antibiotics for the baby are required. A period of monitoring (12-24 hours) may be appropriate for those at highest risk of infection.
Babies born to mothers at increased/high risk who HAVE NOT received antibiotics for four hours before delivery should be:
- Examined thoroughly and investigated by a paediatrician as appropriate.
- Started on intravenous antibiotics until it is known that the baby is not infected, unless the baby is completely well as determined following a robust baby examination carried out by a trained individual.
*GBSS recommends at least four hours of intravenous antibiotics before delivery, where possible – if only two hours administration is possible, this may be sufficient and should give considerable reassurance.
Implementing these recommendations could reduce GBS infection in newborn babies by 60% and deaths from GBS in babies by 70%.
These recommendations will need periodic reappraisal to incorporate advances in technology, new research or other refinements but are we believe the most appropriate for Britain in the light of all data available at present. |
