Wednesday, August 8, 2012
Group B Streptococcal

Group B Streptococcal, other wise known as Group B Strep or GBS, is a bacteria carried by 30 percent of adults in their intestines and 25 percent of women vaginally.  GBS can cause life threatening infections such as sepsis (blood disease), Meningitis (infection of fluid and lining around the brain) and also pneumonia in a newborn or premature baby.  Babies typically get GBS after it is passed from their mother, to them during birth. 

Diagnosing GBS:
  • Every woman is tested for GBS during her pregnancy between weeks 35 and 37.  It is a simple test that just requires a sterile swab (Q Tip) to collect a sample from a woman's vagina and rectum. 
  • If a woman goes into labor before 35 weeks, then her doctor can still perform the swab test when she comes into the hospital. 
  • 25% of pregnant women carry Group B Strep and are considered GBS positive or Group B Strep positive. 
  • Women who test positive for GBS usually show no signs of the bacteria infection, however they are at risk for passing the bacteria on to their baby. 
  • Group B Strep is NOT a sexually transmitted disease
Preventive ways to keep a baby from getting GBS positive:
  • Women who are considered GBS positive will receive antibiotics through an IV during labor.
  • Women who go into labor before week 37 will usually receive antibiotics during labor
  • Women who's water has broke 18hrs or more before delivery will typically receive antibiotics during delivery
  • Women who have fevers during labor will be given antibiotics during delivery.  \
  • Women who have already had a baby with GBS does not need to be tested again, she will automatically be put on antibiotics during delivery.
  • If you are having a scheduled C section and your water has not broke, then you most likely will not need antibiotics. 
  • Women who get antibiotics during labor have a 1 and 4,000 chance of delivering a baby with Group B Strep.  If a Women who is GBS positive does not receive antibiotics during delivery, her baby has a 1and 200 chance of developing Group B Strep positive. 
Signs of GBS Positive in a newborn and premature babies:
  • Difficulty feeding
  • Irritability
  • Hard to wake baby up
  • Difficulty breathing
  • Blue-ish color to skin
  • High/low Temperature
  • low blood pressure
  • high/low heart rate
How it is diagnosed in newborn and premature babies:
  • The only sure way to diagnose Group B Strep in babies is to do a spinal tap to test the spinal fluid for the bacteria. 
Treatment for newborn or premature baby with Group B Strep positive:
  • They are treated with antibiotics through an IV for several days, and sometimes weeks. 

Early onset disease:
  • Early onset disease means that a newborn or premature baby will show signs of having GBS positive within the first week of life, and it is usually within the first day. 
  • For early onset disease Group B Strep usually causes sepsis (infection of the blood), pneumonia and sometimes meningitis. 
Late onset disease:
  • Late onset disease can occur from the first week through three months of life.
  • Late onset disease can have the same infections as early onset disease, however meningitis is more common with late onset disease. 
Long term effects Group B Strep can cause:
  • 25% of babies who have meningitis caused by GBS develop Cerebral Palsy, Hearing problems, Learning problems, and seizures
  • Care for sick babies has drastically improved in the U.S., however 4-6% of babies with group B strep die from their infections.  And premature babies are more likely to die from GBS than full-term babies. 

While researching GBS positive to write this article, I could not find very much information on Group B Strep and premature babies so I will share my daughter Nora's story with you.

Nora was born at 25w5 days.  When I went into labor with Nora I was tested for Group B Strep and I tested positive so they put me on antibiotics during my labor.  I also had a sever infection of my uterus called Chorio, so I had almost every symptom listed above to be put on antibiotics to prevent Nora from getting GBS positive.  I had high fever, UTI, premature labor, infection, and I tested positive for it, so on the antibiotics I went. 

Nora was born with an infection but it was not GBS, it was chorio so she was automatically put on antibiotics at birth for the first 2 weeks of life.  After her birth all we heard about was chorio, so I did not think we had to worry about Group B Strep at all.  3 weeks after Nora was born she came down with another infection, again not GBS.  She was re-intubated and treated with antibiotics for a few days and then we continued on our NICU journey. 

It was not until Nora was 2 months old and 34weeks gestation, that she became extremely sick.  We got a phone call in the middle of the night telling us that Nora had stopped breathing (she was on nasal cannula at .5L and 21% oxygen) and that they were having to constantly stimulate her to breath.  We had been down this road a few weeks earlier when she had gotten the infection, and I never wanted to go down this road again.  My husband and I went up to the hospital, where I held my almost 4lb baby girl and had to pat her back, rub her head and beg her to breath every 2 or 3 minutes.  Nora turned every shade of blue, white and grey and those are colors I never want to see on my child again.  Nora stopped breathing several times in 2 hours and the Neonatologists decided it was time to give her poor body a break and put her back on the ventilator,  run some blood cultures, and put her on antibiotics right away.  They were pretty sure it was an infection, they just had to figure out which one it was.  It was not until about 12hrs later that her blood culture came back showing signs of GBS, so they then did a spinal tap on Nora (her 2nd one in the NICU) and that is when they discovered she had GBS positive. 

I did not know anything about GBS positive and what effects it could have on Nora but I could tell by the reaction of the nurses when they heard her diagnosis that it was not good.  They treated Nora for meningitis, so she was on antibiotics for 21 days and they kept a very close eye on her and anything out of the ordinary that may happen.  Nora decided that after 36hrs she did not want the ventilator anymore and she extubated herself, by pulling her ventilator tube out, and was able to go back to a 1L nasal cannula.  But she was very sick, lethargic, and swollen for several days.  We were told from our Neonatologist that when a baby gets an infection like GBS positive it can set them back for at least 2-4 weeks in their NICU stay because it just takes so long to fully recover from them.  Our Neonatologist also told us it is very rare that they see GBS positive in a baby that is 2 Months old.  He said they usually see GBS positive in the NICU right after birth.  But he said in rare instances they will see late onset disease, where the GBS has been sitting doormat and just resurfaces one day. I will never forget that day but we are so thankful that today, Nora is 6 months old, out of the NICU and doing great! 
If you would like to hear more about Nora's story you can follow her blog at http://purtylittlefowler.blogspot.com/
In researching for this article I used the following websites:

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Precious and priceless so lovable too, the world’s sweetest littlest miracle is, a baby like you.

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