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group B streptococcal septicaemia of the newborn Alternative Names
GBS sepsis
Definition
Group B streptococcus (GBS) is a type of bacteria. Septicaemia is a serious infection of the bloodstream. Newborn infants sometimes develop serious bloodstream infections with GBS bacteria.
What is going on in the body?
The immune system does not mature for several months after birth. For this reason, bacteria such as GBS that do not usually affect older children or adults, easily infect newborns. GBS can actually live in the vagina of normal, healthy women without causing an infection or symptoms.
However, infants born to women with GBS in their vagina may become infected with GBS. The bacteria can be transmitted from the woman's vagina to the baby before or during labour and delivery. In some cases, infants get this infection after birth from other sources. If an infant develops an infection with GBS, it may spread to the bloodstream. The infection can then spread to many areas of the body and may even cause death.
What are the signs and symptoms of the infection?
Infants infected before birth can be born with signs of shock, breathing problems, or even a coma. Usually, however, the infant looks normal at birth. Within the first several hours after birth, the infant may show signs of not doing well, including: - a changing temperature, which may become high or low
- poor feeding
- being difficult to arouse
- turning blue
- breathing problems. These may include rapid breathing, struggling to breathe, a grunting noise while breathing, and abnormal flaring of the nostrils.
- meningitis, which is an infection of the membranes covering the brain and spinal cord. This occurs in about 10% of cases. This may result in a baby that is difficult to arouse. The child may also develop seizures, which are often uncontrollable shaking movements. The child may even go into a coma. The soft spot on the top of a baby's head may bulge outward abnormally.
What are the causes and risks of the infection?
Infection before or during labour and delivery generally only occurs if the mother has GBS in her vagina. An unborn child is more likely to become infected after the mother's water breaks. Infection is also more likely to occur in an infant if: - the child is born prematurely, or before 36 weeks of pregnancy. The more premature the infant, the higher the risk.
- the mother has a fever during labor
- the mother has previously given birth to an infected infant
What can be done to prevent the infection?
This infection is often preventable. Pregnant women should have their vagina and rectum checked for GBS toward the end of pregnancy. If a woman is found to have GBS, she can be given antibiotics during labour. This kills the GBS bacteria in the mother and reduces the chance of infection in the child. Good antenatal care is important to allow the detection and treatment of GBS in the mother. The rate of this infection is actually decreasing. This is because pregnant women are being screened and given preventative antibiotics during labour if they have GBS.
GBS infection acquired after birth is harder to prevent. Infants born to infected mothers should be watched closely for the first several weeks of life. The doctor should see the infant right away if there are signs of infection. People should always wash their hands before handling a newborn, especially after using the toilet.
How is the infection diagnosed?
The doctor often suspects this infection when the infant is not doing well. The child often shows signs of being ill. The diagnosis is made by detecting GBS in the child's body. Samples of blood, urine, and even cerebrospinal fluid may be needed. This fluid surrounds the brain and spinal cord. A sample of this fluid can be obtained by what is called a spinal tap. This involves inserting a needle through the skin of the back into the spinal column. A sample of the fluid can then be taken with the needle for examination.
What are the long-term effects of the infection?
This infection can be quite serious. This is especially true when the infection spreads and affects the brain. There is a small chance of death. The risk of death is highest in very small infants or those who are in shock.
20 to 30% of infants may develop permanent brain damage. This may result in mental retardation, paralysis, seizures, blindness, deafness, and other problems. An additional 15% to 25% of children have milder problems, such as learning difficulties.
What are the treatments for the infection?
Treatment usually begins with antibiotics given through the veins. This treatment may be needed for several weeks. If the infant has meningitis, the doctor may repeat a spinal tap after antibiotics have been started. This is to make sure the fluid around the brain has been cleared of bacteria. If GBS bacteria are still in the fluid, other antibiotics may be added. Other tests and treatments may be needed to check for or treat complications.
Infants with this infection are usually seriously ill. These infants often need care in the intensive care unit.
What are the side effects of the treatments?
All medications have possible side effects. Some of the antibiotics used can cause damage to certain organs. In infants, the inner ear and the kidneys are fairly sensitive. Infants getting antibiotics can develop diarrhoea or even new infections caused by the antibiotics.
The risk of death or serious, long-term problems from this infection is usually much greater than the risk of treatment.
What happens after treatment for the infection?
This infection does not usually return after treatment, though it is possible.
How is the infection monitored?
In the first few weeks after treatment, the infant should be watched closely for signs of illness. This may mean a return of the infection. The infant should also be followed closely to watch for any sign of hearing, vision, or development problems. Other problems involving the brain, such as paralysis, must also be watched for. If these problems occur, they will often need complicated, long-term treatment.
Author: John Wegmann, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
