Group B Strep can cause devastation to parents, and is an incredibly sensitive topic. Our intense need to make things better for ourselves and others can work miracles in preparing for challenges and avoiding harm, and is an inherent blessing to humanity.
So many areas in life are poorly studied that it can sometimes be difficult to filter through research and know what to believe. This blog post is an effort to address some of the evidence towards navigating a diagnosis of GBS.
Sara Wickham is a UK based evidence warrior who has done most of the work for us. Her article here talks through a Cochrane Review (before or after reading the article, you can hear about what a Cochrane review means here):
It eliminates certain research and therefore could miss a point of interest or concern that seems relevant to small groups or individuals, but it does give a good overview of major studies in a particular field, such as, in this case, interventions for GBS.
Summary and discussion
This area of practice is a controversial one. As the reviewers note, the pressure to implement some kind of prophylaxis came from parents and the media, and it is easy to understand how the experience of losing a baby could lead to a desire to do something in order to prevent others from having the same experience. Unfortunately, there is no way of preventing all cases of GBS disease, there is a lack of evidence of effectiveness of intrapartum antibiotic prophylaxis and there are significant ramifications of continuing to recommend this to large numbers of women. While there exist a number of examples of maternity care in which practice does not correlate with the evidence, the fact that the reviewers see further research as being limited because of the current guidelines in place in many areas makes this situation particularly extreme. The combination of the pressure to ‘do’ something in an attempt to prevent tragedy and the perceived difficulty of going against entrenched guidelines – whether or not they are evidence-based – would appear to have led to a situation where we may be doing more harm than good, without any means of working out if and how we could do better.
Perhaps the single, most compelling way forward is to educate parents on warning signs of ANY infection, and to campaign for and insist on excellent responses from Healthcare Staff to readmit any baby not thriving, or around whom the parents have concerns.
http://gbss.org.uk/infection/ gives a comprehensive list of warning signs that every parent should be familiar with:
In the UK, up to two-thirds of GBS disease is early onset (apparent within the first week).
Early onset GBS infection usually presents as sepsis with pneumonia. These “early-onset” infections are usually apparent at or soon after birth, with the typical signs of early-onset GBS infection including:
- Grunting, noisy breathing, not breathing at all, moaning, or seems to be working hard to breathe when you look at the chest or tummy.
- Be very sleepy and/or unresponsive
- Inconsolable crying
- Be unusually floppy
- Not feeding well or not keeping milk down
- Have a high or low temperature (if parents have a thermometer), and/or be hot or cold to the touch
- Have changes in their skin colour (including blotchy skin)
- Have an abnormally fast or slow heart rate or breathing rate
- Have low blood pressure (identified by tests done in hospital)
- Have low blood sugar (identified by tests done in hospital)
The reason knowing these signs is so important is that it’s protective against OTHER forms of illness also requiring urgent medical follow-up. We are limited in what we can test for, and as we’ve seen testing +ve for a virus or bacteria does not confirm infection in all cases anyway, but any of the above warning signs certainly DO warrant further testing.
With the NHS facing a serious and sustained strain on staffing levels, parents sometimes have to INSIST on assessment in order to treat an infection, or gain help with breastfeeding, or have their own wounds checked for appropriate healing.