Neonatal group B streptococcal infection in South Bedfordshire, 1993–1998

Kathryn Beardsall; M H Thompson; R J Mulla

doi:10.1136/fn.82.3.F205

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Neonatal group B streptococcal infection in South Bedfordshire, 1993–1998

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Confirmed GBS infection - the tip of the iceberg
AR Bedford Russell
Published on: 9 January 2022
Guidelines for Group B streptococcus
Kathryn Beardsall
Published on: 9 January 2022
Guidelines for prevention of neonatal Group B Streptococcal infections
Yim-Yee Chan
Published on: 9 January 2022

Published on: 9 January 2022
Confirmed GBS infection - the tip of the iceberg
- AR Bedford Russell, Consultant Neonatologist
Dear Editor:
Beardsall et al are to be congratulated on presenting further evidence that group B streptococcus (GBS) gives rise to a significant burden of disease in some areas of the United Kingdom.[1] Retrospective data collected at St George’s is in agreement with the authors’ suggestion that culture proven sepsis under-represents the true burden of disease.
Firstly we conducted a retrospective search...
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Dear Editor:
Beardsall et al are to be congratulated on presenting further evidence that group B streptococcus (GBS) gives rise to a significant burden of disease in some areas of the United Kingdom.[1] Retrospective data collected at St George’s is in agreement with the authors’ suggestion that culture proven sepsis under-represents the true burden of disease.
Firstly we conducted a retrospective search for cases of culture- positive GBS (either blood or cerebrospinal fluid) among a cohort of consecutive births at St George’s between 1/1/94 and 31/10/98, comprising 16,910 births.
Secondly we conducted a retrospective analysis of all babies colonised with GBS (deep ear swabs taken in the first 6 hours of life which were positive for GBS), and who were screened and treated for suspected early onset infection in the first 72 hours of life, during the period 01/04/97 to 31/03/98. Probable early onset GBS (EOGBS) infection was defined as:
a positive deep ear swab in a baby with clinical pneumonia or sepsis (either fever >38^oC on one occasion or >37.5^oC on 2 occasions separated by at least one hour
or 2 or more of:
poor perfusion, respiratory distress, thrombocytopenia, leucopenia <_5 x="x" _10sup="_10sup"/>9/l, persisting glucose imbalance or abdominal distension, bilious aspirates or blood in stool) in a baby <_72 hours="hours" of="of" age.="age." p="p"/> Twelve of 16,910 babies had blood cultures positive for GBS, and GBS was cultured from cerebrospinal fluid of one baby whose blood culture was negative. This gives an infection rate of 0.77/1000.
Of 3438 deliveries from 01/04/97 to 31/03/98, there were 9 babies with probable GBS infection, giving an incidence of 2.6/1000.
Because of the usual problems related to retrospective data analysis this figure is likely to still under-represent the true burden of disease. We are currently prospectively evaluating the incidence of probable as well as proven GBS infection in order to estimate the true burden of disease in our local population. It is only in the light of such data that we will be able to develop evidence-based guidelines for the prevention and management of this disease.
AR Bedford Russell
Aodhan Breathnach*
Paul Sender
Neonatal Unit and Medical Microbiology & PHLS Collaborating Centre*
St George’s Hospital
Blackshaw Road, London SW17 OQT, UK
(1) Beardsall K, Thompson MH, Mulla RJ. Neonatal group B streptococcal infection in South Bedfordshire 1993-1998. Arch Dis Child Fetal Neonatal Ed 2000;82:F205-7.
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Conflict of Interest:
None declared.
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Published on: 9 January 2022
Guidelines for Group B streptococcus
- Kathryn Beardsall, Neonatal Specialist Registrar
Dear Editor
As highlighted in a recent edition of ADC Fetal and Neonatal edition,[1, 2] there is increasing concern about the previously unreported high levels of neonatal group B Streptococcal (GBS) infections in the UK. It is indeed most important that we have national statistics for regional variations in GBS infection, for it is only when we have this information that we can begin to produce evidence based guid...
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Dear Editor
As highlighted in a recent edition of ADC Fetal and Neonatal edition,[1, 2] there is increasing concern about the previously unreported high levels of neonatal group B Streptococcal (GBS) infections in the UK. It is indeed most important that we have national statistics for regional variations in GBS infection, for it is only when we have this information that we can begin to produce evidence based guidelines. It is however important that as well as establishing the true incidence of GBS in the UK that we are also clear about the data on which we base our recommendations.
In the commentary following our paper entitled Neonatal Group B Streptococcal Infection in South Bedfordshire[2] Nicoll and Heath refer to the incidence at which a risk factor based versus a screening approach to the prevention of Group B Streptococcus would be cost effective, quoting from a commentary by Isaacs.[3] The original article by Mohle-Boetani et al[4] from which these data were derived, actually gives figures of >0.65 and >1.45/1000 live births at which a risk factor and screening based approach, respectively would be cost effective. This contrasts with those quoted by Isaacs,[3] and Nicoll and Heath[1] of 0.6 and >1.2/1000 live births.
More importantly it should be noted that these figures are obtained from a study which used significantly different criteria for both the definitions of a risk factor and on the decision to treat. In the paper by Mohle-Boetani et al[4] the risk factor approach for treatment involved treatment of both "teenagers or Blacks who developed labor complications". The latter included either a temperature of >37.5ºC or prolonged rupture of membranes (PROM) for >12 hours or preterm labor <_37 weeks="weeks" of="of" gestation.="gestation." this="this" is="is" obviously="obviously" a="a" quite="quite" different="different" population="population" from="from" those="those" defined="defined" in="in" the="the" cdc="cdc" guidelines5="guidelines5" where="where" all="all" mothers="mothers" who="who" go="go" into="into" preterm="preterm" labour="labour" _37="_37" gestation="gestation" or="or" have="have" prom="prom" _="_"/>18 hours) or have a temperature (>38ºC) would be offered treatment under a risk factor based strategy. The screening group in the paper by Mohle-Boetani et al[4] were screened at 26-28 weeks gestation not 34-35 weeks as in the CDC guidelines, the latter interval being considered to be when colonisation status is most predictive of colonisation at delivery. Also treatment was only given if the mothers also developed intrapartum risk factors, (temperature >37.5º C or PROM >12 hours or preterm labor).
Mohle-Boetani et al conclude "The strategy we developed is not generally applicable because different populations might have different risk factors for delivery of infants with GBS disease." In the study population 40% of births occurred in women who were teenagers or Black.
It is important that before these figures become established in the current literature we review the original data and the premises on which it is based. It is important to pay attention to crucial differences in the composition of different populations and the risk factors employed in different studies. As new guidelines are being developed we should not make recommendations based on incorrect information.
References
(1) Nicoll A, Heath P. Commentary. Arch Dis Child Fetal Neonatal Ed 2000;82:F207.
(2) Beardsall K, Thompson MH, Mulla RJ. Neonatal Group B streptococcal infection in South Bedfordshire, 1993-1998. Arch Dis Child Fetal Neonatal Ed 2000;82:F205-7.
(3) Isaacs D. Prevention of early onset group B streptococcal infection: screen, treat, or observe? Arch Dis Child Fetal Neonatal Ed 1998;79:F81-2.
(4) Mohle-Boetani JC, Schuchat A, Plikaytis BD, Smith JD, Broome CV. Comparison of prevention strategies for neonatal group B streptococcal infection. A population-based economic analysis. JAMA 1993;270:1442-8.
(5) Centers for Disease Control. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR May 31, 1996;45(RR-7):1-24.
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Conflict of Interest:
None declared.
- Back to top
Published on: 9 January 2022
Guidelines for prevention of neonatal Group B Streptococcal infections
- Yim-Yee Chan, Research Fellows
- Other Contributors:
  R Lakshman
Dear Editor
The article by Beardsall et al[1] once again raises awareness of this important and as yet unresolved issue for the UK. We would like to make two related points:
(1) Although the authors have discussed both early and late onset Group B Streptococcus disease, perinatal intervention is effective in preventing only early onset Group B Streptococcus disease.
(2) A common related scenario...
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Dear Editor
The article by Beardsall et al[1] once again raises awareness of this important and as yet unresolved issue for the UK. We would like to make two related points:
(1) Although the authors have discussed both early and late onset Group B Streptococcus disease, perinatal intervention is effective in preventing only early onset Group B Streptococcus disease.
(2) A common related scenario is of a healthy newborn who is colonised with Group B streptococcus. Management strategies vary from no intervention to antibiotic prophylaxis (intramuscular Benzyl Penicillin or oral Penicillin V or Amoxycillin) for 7 to 14 days. It would be useful if the British Paediatric Surveillance Unit could gather data that would lead to evidence based guidelines for management of these babies.
Reference
1. Beardsall K, Thompson MH, Mulla RJ. Neonatal group B streptococcal infection in South Bedfordshire, 1993-1998. Arch Dis Child Fetal Neonatal Ed 2000;82:F205-7.
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Conflict of Interest:
None declared.
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