Assessing standards for prevention of early onset group B streptococcal (GBS) disease in Ireland

Abstract

Background: Early onset group B streptococcal (GBS) disease can cause significant neonatal morbidity and mortality. There is currently no Irish national guideline for GBS screening, and protocols vary across maternity units. Polymerase chain reaction (PCR) testing at induction or labour onset informs triage for antibiotic prophylaxis; however, there are human and infrastructural resource requirements to enable widespread implementation. Aim: Our aim was to identify current standard practices for GBS prevention in Irish obstetric and neonatal services and to utilise this data to inform the need for, and potential impact of implementation of, a national guideline. Methods: A questionnaire on GBS screening, management and existing resources was completed by an informed staff member from each of the 19 Irish maternity units, including questions regarding timing and method of screening, antibiotic usage, and neonatal management. Results: One unit (5.2%) performs routine GBS screening at 35–37 weeks of gestation. Twelve units (63%) screen for GBS following spontaneous rupture of membranes (SROM) after 37 weeks, of which two (17%) perform PCR and ten (83%) culture testing. Seventeen units (89.3%) have access to a GeneXpert PCR machine, and of these, two (11.7%) use the machine for rapid GBS testing. Two units screen patients for GBS at either the start of labour or induction of labour. Four units (21%) use the neonatal early onset sepsis (EOS) calculator. Sixteen units (84%) do not treat asymptomatic infants born to GBS-positive mothers. Conclusion: There is a lack of consistency in the methods for GBS screening and disease prevention across the country, highlighting the need for a national guideline accompanied by an implementation plan and budget to standardise care.

The full blood count in screening asymptomatic infants for early‐onset sepsis: A cross‐sectional study

“…The updated guidelines also omitted these recommendations for the following infants (which were present in the pre‐November 2019 guidelines): (1) infants born to mothers with a maternal pyrexia in labour or within 4 h after delivery and (2) infants born to mothers for whom maternal intrapartum antibiotic prophylaxis was not deemed sufficient (which include infants born at <37 weeks gestation, infants born following a prolonged rupture of membranes >18 h and infants born to mothers with any history of GBS carriage in the current pregnancy). The NEOSC is currently in use in two of the four maternity units in Ireland with >6000 deliveries per year 13 …”

“…12 In Ireland, while there is significant variation in practice between maternity units, in general units follow a risk-based approach to the prevention of EOS. 13 In the Rotunda hospital, intrapartum GBS PCR is performed on women with term spontaneous rupture of the membranes who are not in labour and on women who are having elective inductions. Women who present in active labour are managed using a risk factor-based approach, and women in preterm labour receive IAP.…”

“…The NEOSC is currently in use in two of the four maternity units in Ireland with >6000 deliveries per year. 13 Both pre-and post-November 2019 guidelines suggest discontinuation of prophylactic antibiotic therapy after 36 h unless the infant develops clinical illness has positive blood cultures, or a decision to continue antibiotics is made at the discretion of the neonatal team.…”