Avoidable Injuries Caused By Group B Strep

There are six situations where a newborn baby is known to have a higher risk of developing group B Strep infection.

• Mum has had a previous baby infected with group B Strep
• Group B Strep found in Mum's urine during this pregnancy
• Mum has a raised temperature during labour (37.5°C or higher)
• Group B Strep found on a vaginal or rectal swab during this pregnancy
• Labour starts or waters break before 37 weeks of pregnancy
• Waters break more than 18 hours before delivery

The UK’s Royal College of Obstetricians & Gynaecologists (RCOG) recommends that intravenous antibiotics should be offered to Mums in labour to minimise the risk of group B Strep infection in their newborn baby in a smaller four situations:

• Mum has had a previous baby infected with group B Strep
• Group B Strep is found in Mum's urine during the current pregnancy
• Mum has a raised temperature during labour (37.5°C or higher) or other symptoms of chorioamnionitis (infection of the membranes around the baby)
• Group B Strep found on a vaginal or anorectal swab during the current pregnancy

The new guidelines which are currently awaiting publication also recommends intravenous antibiotics in pre term labour.

Carrying group B Strep before the current pregnancy is not a good predictor of carrying group B Strep now. You are more likely to be carrying it again if you have been a carrier before this pregnancy but, without a positive group B Strep test result during the current pregnancy, you will not be offered intravenous antibiotics in labour unless one or more of the other risk factors is present.

If you have tested positive for carrying group B Strep during your current pregnancy then the following should happen:-

Treatment in Labour You should be offered antibiotics and if you decide to take it, you should be given the first dose of intravenous antibiotics as soon as possible once labour has started and then at regular intervals until delivery to prevent group B Strep infection in your new born baby.

Current guidelines recommend that antibiotics should be given for a minimum of two hours before delivery, although the updated RCOG guidelines which are currently awaiting publication have increased this to a minimum of four hours.

Care after birth* Babies born at an increased risk to mums who have received antibiotics for more than 2 hours before delivery should be carefully assessed by an appropriately trained Paediatrician, advanced Neonatal Nurse Practitioner or Midwife. If your baby is completely healthy then no antibiotics are required but a period of monitoring, usually 12 to 24 hours may be appropriate for those at a higher risk of infection.

Babies who are born at an increased risk to mums who have not received antibiotics for more than 2 hours before delivery should be examined thoroughly and investigated by an appropriately trained Paediatrician, advanced Neonatal Nurse Practitioner or Midwife. If your baby is completely healthy no antibiotics are required but your baby should be observed for a minimum of 12 hours and ideally 24 hours.

For well babies at the highest risk of infection, 12 – 24 hour monitoring may be appropriate and should be undertaken as a minimum if the baby is not screened and treated for infection.

If there is any doubt as to whether an infection is present, the baby should be started on intravenous antibiotics until it is known that they are not infected.

Parents should be made aware of the earliest sign of infection and given literature about group B strep infection. *Reference www.gbss.org.uk

How is group B Strep infection diagnosed? Group B Strep infection is diagnosed following a blood or urine test or sometimes by testing spinal fluid. Regrettably, none of the tests for group B Strep infection in new born babies are 100% reliable and occasionally, the tests give false negative results. This means that blood cultures are negative, even though the baby has signs consistent with group B Strep infection. If swabs from the baby’s skin and/or the mother are positive for group B Strep and a blood marker called a CRP is raised, this indicates the presence of infection. When this happens doctors may make a presumed diagnosis of group B Strep infection, based on the baby’s clinical history on examination.

Early onset group B Strep infection Two thirds of babies who develop group B Strep infection develop signs in their first 6 days of life and of these, almost 9 out of 10 show signs within 12 hours of birth. Early onset group B Strep infection babies usually develop septicaemia or pneumonia and less frequently it shows as meningitis.

Often an infected baby shows signs of having difficulty breathing at, or within a few hours of delivery and may need additional oxygen support.

Early onset group B Strep infection is more frequently associated with prematurity, ruptured membranes (waters breaking) for more than 18 hours prior to the birth, mum having a fever in labour and with mum carrying group B Strep.

Signs of early onset group B Strep infection in new born babies include:-

• Rapid breathing or stopping breathing;
• Making grunting noises;
• Poor feeding;
• Being abnormally drowsy;
• Being irritable;
• High/low temperature;
• High/low heart rate;
• Low blood pressure;
• Low blood sugar;
• Pale, blotchy skin

Late onset group B Strep infection Late onset group B Strep infection occurs after 6 days of life. It is uncommon after a baby is 1 month old and very rare after 3 months old and usually presents as meningitis and septicaemia.

Typical signs are similar to those of early onset infection but may also include signs associated with meningitis such as:-

• Being irritable with a high pitched or whimpering cry or moaning;
• Blank, staring or trance-like expression;
• Floppy;
• Tense or bulging fontanelle;
• Turns away from bright light;
• Involuntary stiff moving body or jerking movements

Group B Strep infection can be effectively treated with prompt intravenous antibiotic therapy and intensive care. The minimum recommended length of IV antibiotic treatment for babies diagnosed with group B Strep infection is usually at least 7 days if meningitis is not present and at least 14 days if it is. If your baby has developed other medical problems in addition to group B Strep infection (for example; jaundice) this will also need to be treated.

Do I have a claim for medical negligence? With prompt treatment, most babies with group B Strep infection make a full recovery. However, approximately 50% of babies who recover from group B Strep meningitis will have long term problems and in fact in 1 in 8 of these cases, these will be severe. It is for this reason that prompt treatment is vital.

If, during your labour, you have one of the risk factors whereby the RCOG recommend administration of IV antibiotics and these weren’t administered, or your baby showed signs of infection but these weren’t investigated or acted upon then you may have a claim for medical negligence.

Claims for group B Strep are usually complex cases with the child usually having suffered life changing injuries or sadly having died from the infection. Often the effects of undiagnosed or untreated group B Strep are catastrophic affecting the whole family. The family of someone who has suffered a complication of group B Strep infection such as meningitis will be left trying to get help with care needs and manage with a reduced family income, if they have had to give up work to care for the injured child and damages recovered for the injured child can help to ensure that the best possible quality of life is enjoyed by the child, throughout their life, however long that may be.

In order to succeed in a medical negligence claim it is necessary to prove that the Doctor (i) owed you a duty of care, (ii) was in breach of his/her duty of care, and (iii) the breach caused you to suffer an injury.

If your baby has been ill with a group B Strep infection or you have sadly lost a baby through group B Strep which you believe has been as a result of medical errors during your pregnancy, labour or shortly after your baby’s birth and would like a no obligation discussion, please contact Elizabeth Smith on 01752 292309 or esmith@wolferstans.com