Group B Strep in Newborns

What's the Problem?

Group B strep infection is the leading cause of life-threatening infection (meningitis, sepsis) in newborn infants. A pregnant woman may unknowingly pass group B strep to her infant during labor and delivery. A newborn might appear perfectly healthy at birth, then suddenly develop fever, lethargy, and difficulty breathing. Shortly thereafter, the baby may develop meningitis, sepsis, or pneumonia and, in extreme cases, may die. If the baby survives, years later the child may develop hearing loss, vision loss, or mental retardation. In the pregnant woman, group B strep can cause urinary tract infection, preterm birth, and miscarriage.

Who's at Risk?

One in four women carries Group B strep bacteria, which is transmitted easily by touching the nose, face and eyes, or through sexual contact and breathing. Most women show no symptoms. There are about 7,600 Group B strep cases annually in newborns, and death occurs in about 1 in 20. Disease rates are higher among infants born to African-Americans of all age groups and among infants born to women under 20 years of age.

Can It Be Prevented?

Yes. Most group B strep infections can be prevented by a simple screening test. In the fall of 2002, CDC will release revised guidelines that recommend screening for all pregnant women. The screening test requires a vaginal and rectal swab between 35 to 37 weeks of gestation. Women who are carriers of GBS can be treated with intravenous antibiotics during labor to help prevent transmission of the disease to their newborn.

The current guideline indicate treatment with intravenous (IV) antibiotics during labor and delivery in the following cases:

• pregnant women who test positive for GBS;
• women who deliver prematurely; and
• women with pregnancy risk factors (fever, premature rupture of membranes, previous group B strep baby) whose screening results are not available at the time of delivery.

It is important for women to know about this disease and the screening test because many hospitals do not have policies that require physicians to practice prevention strategies with antibiotic therapy at delivery. In hospitals without group B strep prevention policies, many pregnant women never hear about this disease until it has already been transmitted to the newborn.

The Bottom Line

• Group B strep infection can have adverse effects on a pregnant woman and her newborn.
• Screening and treatment of the mother easily prevent infection.
• All pregnant women should talk to their health care providers about GBS and request screening.

Case Example

A pregnant African-American woman is in early labor in a busy trauma center at the same hospital where she received her prenatal care. She successfully delivers an apparently healthy baby boy. While in the mother's arms a few hours later, the infant cries and suddenly struggles to breathe. A nurse immediately takes the baby to the intensive care nursery. Specialists suspect the baby has group B strep infection. The baby is diagnosed with pneumonia and is put on a ventilator. The next day, the pneumonia causes the baby's lungs to fail and the ventilator can no longer oxygenate his blood. The baby's only chance for survival is surgery and attaching him to a special machine to oxygenate his blood and allow recovery from the infection. The baby appears bluish and the distraught parents consent. After a few days in intensive care, the infant recovers and goes home, but it is not clear if the infection has caused long-term neurological problems.