Based on RCOG Green Top Guideline No. 36 2017 update
See also Infection in first 72 hours of life guideline
BACKGROUND
- Mortality from Group B streptococcal (GBS) infection:
- term: 2–3%
- preterm: 20–30%
- Baby infected with GBS has a 1 in 19 risk of dying and 1 in 14 survivors will have long-term disability
- 90% of babies with early onset GBS infection are symptomatic within 12 hr of birth
- A mother colonised with GBS during pregnancy has a 50% risk of colonisation in subsequent pregnancies
- Colonised mother who had a previous baby affected by GBS has a greater chance of having another affected baby, than a colonised mother who has not had an affected baby
- Intrapartum antibiotic prophylaxis (IAP) does not prevent late onset GBS infection
INTRAPARTUM ANTIBIOTIC PROPHYLAXIS
- Offer IAP to:
- mother identified as colonised with GBS during pregnancy
- any growth of GBS is significant (urine, rectum or vagina), whether identified accidentally/routinely
- mother with previous affected baby
- preterm labour (including without known GBS colonisation)
- mother identified as colonised with GBS during pregnancy
- IAP not required for planned delivery by caesarean section with intact membranes and in the absence of labour
MANAGEMENT OF BABY
- No action required for term baby whose mother received IAP >4 hr before delivery
- If IAP was indicated but not given/declined or if delivery was within 4 hr of first dose of IPA:
- baby to be reviewed for signs of infection
- neonatal observations at 0, 1, and 2 hr and then 2-hrly until 12 hr
- early discharge (within 24 hr of birth) to be avoided
- RCOG does NOT recommend blood culture and/or antibiotic prophylaxis
- If baby appears unwell follow Infection in first 72 hours of life guideline)
ADVICE FOR PARENTS
- Parents/carers should seek urgent medical advice if they are concerned baby shows any of the following:
- abnormal behaviour (e.g. inconsolable crying or listlessness)
- unusually floppy
- onset of difficulties feeding or intolerance of feeds
- temperature <36°C or >38°C not explained by environmental factors
- change in skin colour
Date updated: