For the past 15 years, North Americans have struggled to quantify and cost neonatal early onset group B streptococcal (EOGBS) infection, and to outline strategies for its prevention. A 24 page document has now been issued by the Centers for Disease Control in Atlanta,1 which has been endorsed by the American College of Obstetricians and Gynecologists,2 and by the American Academy of Pediatrics.3

The core recommendation is the use of penicillin G, given intravenously to women in labour, to reduce the risk of neonatal (and maternal) EOGBS infection. The guidelines discuss the use of one of two strategies to decide which women should receive intrapartum antibiotic prophylaxis. One strategy is based on rectal and vaginal surveillance cultures taken at 35–37 weeks gestation, with intrapartum antibiotics given to all group B streptococcal carriers. The other strategy identifies women who are treated on the basis of risk factors for neonatal sepsis, but without prenatal screening cultures.

These recommendations revise pre-existing guidelines about which paediatricians and obstetricians could not agree, and which, consequently, were not widely implemented.

Over the same 15 year period in the United Kingdom, an eerie silence on the same subject has prevailed. The incidence of EOGBS infection in the UK is almost certainly lower than that in the USA, where it is estimated that in 1990, a national incidence of 1.8 cases per 1000 live births caused 7600 EOGBS neonatal infections and 310 neonatal deaths.1