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Sunday, 21 April 2013

Group B Streptococcus

To have or not have intrapartum antibiotic prophylaxis (IAP) if you have been found to have Group B Streptococcus (GBS)?

A recent Cochrane review of IAP found insufficient evidential support for IAP in terms of reducing early-onset GBS in the baby, that is infection in the first week.  This review can be found here.
90% of GBS infection in babies occurs in the first week.

What about later onset GBS disease in babies (that 10% which occurs between 7 days and three months of age)?  IAP has been found to lessen the severity of later onset GBS disease in babies in a recent retrospective cohort study.  However later onset GBS is rare, affecting around 1 in 4000 term babies.  The authors of this paper agree that GBS transmission is poorly understood and that IAP is insufficient to prevent mother-to-baby transmission.

It is a personal decision whether to have IAP but the evidence supports a decision to decline IAP every bit as much as it supports the decision to go along with it.

What is important is the recognition of GBS disease in a baby and an effective response to that by parents and healthcare services.  GBS is not a contra-indication to homebirth whatever the parents' decision is about IAP.

Signs of GBS in a baby:
- Poor feeding
- Lethargy
- Irritability
- High or low temperature
- High or low or irregular heart rate 

Anxious or stressed appearance
- Blue appearance (cyanosis) or paleness (pallor) with cold skin
Breathing difficulties such as flaring of the nostrils, grunting noises, rapid breathing, short periods without breathing

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