Prevention of early-onset Group B Streptococcal disease - the Northern Ireland experience

Abstract

Objectives: To ascertain guideline adherence for prevention of Group B Streptococcal (GBS) neonatal infection and establish prevalence and outcomes in Northern Ireland (NI).

Design: Retrospective observational study.

Setting: Northern Ireland maternity units.

Population: Using NI Health Information Systems the following were identified: (1) a cohort of women with one or more risk factors for GBS disease in 2009-2010, (2) all culture-positive cases of GBS in babies aged 0-89 days (2008-2010), (3) stillbirths due to GBS (2009-2010).

Methods: Information was analysed for a 15% randomised sample of the available cases. Maternal and infant case notes were reviewed for confirmed cases of neonatal early onset GBS (EOGBS) during 2008-2010.

Main outcome measures: Adherence to the 2003 RCOG guideline on prevention of GBS disease (2009-2010). Number of neonatal GBS infections: antenatal risk factors, management and neonatal outcomes (2008-2010). The number of stillbirths related to GBS (2009-2010).

Results: Five hundred and seventy-four women had one or more identifiable risk factors for GBS disease; intrapartum antibiotic prophylaxis (IAP) was administered in 42% of cases. Improved administration of IAP was noted in the presence of escalating risk factors. At best, guideline adherence was 50-70%. Forty-three neonates had proven early-onset Group B Streptococcal disease; 55.8% had maternal risk factors. Of the total identified cases, 25.5% received IAP. The total mortality rate was 11.46%. The incidence of EOGBS disease in NI was 0.57/1000 live births.

Conclusions: Prevalence of EOGBS is higher in NI than the UK as a whole. Risk factors are present in 55.8% of mothers; IAP does not prevent all cases of EOGBS.

Keywords: Anaphylaxis; Group B Streptococcal disease; intrapartum antibiotic prophylaxis; neonatal infection.