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Group B Streptococcus in Pregnancy and Newborn
Group B Streptococcus in Pregnancy and Newborn
Group B Streptococcus in Pregnancy and Newborn
• 0.12 per 1000 live births (range 0.11 to 0.14 per 1000 births)
• 10 – 30 % of pregnant women
• Mostly asymptomatic
Neonatal colonization
• Vertical transmission
• horizontal transmission
• Higher transmission rates - when women are persistently culture
positive carriers or when women are heavily colonized
• The most important determinant of susceptibility - maternal
antibodies directed against the capsular polysaccharide antigens of
GBS.
MATERNAL RISK
Urinary tract infection
• Asymptomatic bacteriuria
• Cystitis
• Pyelonephritis
• The risk of adverse outcome - decreased with antibiotic treatment of
asymptomatic bacteriuria.
Asymptomatic bacteriuria
• 7 to 30 %
• 2 - 14 % of cases
• Endocarditis
• Abdominal abscess
• Necrotizing fasciitis
Fetal risks
• Premature rupture of membrane
• Preterm birth
• Still birth
NEONATAL RISKS
Neonatal GBS infection
• 0.5 per 1000 live births
50% 50%
Non-colonized Colonized
newborn newborn
1-2 %
98%
Asymptomatic Early-onset sepsis, pneumonia,
meningitis
Epidemiology
• Early-onset disease – declined from 1.8 cases per 1000 live births in
1990 to 0.24 cases per 1000 live births in 2016
- Ethnic disparity
• Late-onset - after the first week of life until 3 months of age with a
range of 3 to 4 weeks.
Early onset
Sepsis
• 80 - 85%
• Many infants presenting at <24 hours after birth do not have fever
• Meningitis : 7 % , uncommon
presents with signs of -
central nervous system inflammation
respiratory abnormalities (eg, tachypnea, grunting, apnea)
Late onset
• Often presents as bacteremia without a focus (approximately 65 % of
cases)
• However, meningitis (25 - 30 %) and focal infections also occur
• Bacteremia — Infants with late-onset infection commonly present
with fever ≥38°C.
May have a history of a preceding or intercurrent upper respiratory
infection.
Other - irritability, lethargy, poor feeding, tachypnea, grunting, and
occasionally apnea.
Late onset
• Meningitis : 25 to 30 % of cases of late-onset
- Indistinguishable from that of neonatal sepsis without meningitis.
• Blood culture
• Urine culture
• Empiric therapy — broad spectrum antibiotics to cover for early- and late-
onset disease in neonates and infants younger than three months of age
• Treatment of all women during labor who have specific risk factors for
early onset GBS infection