Sir Nicholas Soames MP, Patron of Group B Strep Support, opened the conference by articulating the charity's over-arching objective: "To reduce preventable GBS infection in babies. Save infant lives, prevent disability and prevent pain and suffering. To support and inform families affected with GBS and educated health professionals..." Sir Nicholas called on delegates to listen to the discussions closely and carefully, with an open mind. Click here to read the transcript
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Dr Alison Bedford Russell described how clinical presentations of group B Strep were different between early-onset and late-onset. For example, group B Strep meningitis was more common in late-onset than early-onset GBS infection, while pneumonia was the reverse. Focal infection (infection in a particular area of the body) was "very,very rare" when it came to early-onset, and less rare for late-onset, for example, septic arthritis. Overall, generalised sepsis was the most common presentation. Dr Bedford Russell highlighted some of the difficulties of identifying early-onset GBS infection and also spoke of an increase in newborns presenting with "hypoxic ischemic encephalopathy" also referred to as HIE, a type of brain damage. The number of deaths as a result of group B Strep infection [...]
Dr Catherine O’Sullivan – The burden of invasive GBS disease in young infants in the UK & Republic of Ireland 2014-2015
Dr Catherine O'Sullivan presented a comprehensive analysis of 817 cases of invasive group B Strep in infants under 90 days old, where the samples were drawn from sterile sites such as blood culture or spinal fluid. "In looking from 2014 to 2015, again preliminary, but what we have at the moment, we have an incidence of 0.89 per 1,000 live births which is an increase from 2000-2001 where it was 0.72. Also in those 14-15 years we have seen increased incidence across all countries." Click here to read the transcript Click here to view the slides
Dr Theresa Lamagni focussed on the epidemiology of invasive group B Strep disease across all age groups from 1991 onwards, using data from Public Health England Laboratory reports between 1991 and 2014. There was a more in-depth focus on 2014 using this data supplemented with Hospital Episode Statistics data and NHS demographic batch tracing. Dr Lamagni observed that there had not been the hoped-for drop in the incidence of GBS disease following the Royal College of Obstetricians and Gynaecologists guidelines at the end of 2003. "The rates of early-onset and late-onset disease have not decreased since the introduction of prevention guidelines and that's really quite disappointing." Click here to read the transcript Click here to view the slides [...]
Prof Philip Steer – GBS prevention strategies – UK & International (risk based, screening and vaccination)
Prof Philip Steer considered the two major approaches to preventing group B Strep infection in newborn babies: one based on antenatal screening and the other based on identification of risk factors during pregnancy. Identification of risk factors is the approach currently recommended by the Royal College of Obstetricians and Gynaecologists (RCOG) and in use in the UK. "The risk factor approach is very inconsistent - it's very confusing for professionals and certainly for women at large." Click here to read the transcript Click here to view the slides
Prof Alan Cameron set out the UK National Screening Committee's (NSC) current policy position on antenatal screening for GBS carriage (2012): Routine screening for GBS carriage in late pregnancy for all pregnant women is currently not recommended in the UK. There was insufficient evidence that benefits gained from screening all women in late pregnancy and treating those women with confirmed GBS carriage by intravenous antibiotics during labour outweigh harm. The next review by the National Screening Committee is due in 2015/16. "We certainly feel that more evidence is needed about the care received by women to refine national policy in the prevention of early-onset GBS infection, to standardise local guidelines and to ultimately reduce the incidence of [...]
Dr Andrew Thomson provided insight into the introduction of the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines. He stated that the process to revise the RCOG GBS guideline is now underway, "if the evidence was compelling that we needed to change the practice, then we could revise a guideline in one year or less." "The RCOG GBS guideline initially published in 2003 and revised in 2012 concluded that routine bacteriological screening of all pregnant women for antenatal GBS carriage is not recommended. So we grade our recommendations and this is given as a grade D recommendation and the evidence for that is given underneath and its evidence level 4. And you see what is that recommendation based [...]
Prof Neena Modi started the Q&A by asking what has been done to improve the evidence base in order to form the development of really robust guidelines. Prof Philip Steer responded that there was a need to improve the information about the impact of screening versus risk factors, but that it was highly unlikely that a screening RCT (randomised control trial) would be funded in the UK. This meant reliance on evidence from experts. This was followed by a discussion about the use of antibiotics, their potential to affect a mother's faecal flora and the potential impact on development of the neonatal immune system. There was also a discussion about how much the RCOG guidelines were actually being followed, and [...]
Prof Androulla Efstratiou spoke first about microbiological screening. Currently: Most units did not use a sensitive test to detect GBS carriage*. Risk factors recommended by RCOG to select women for antibiotics in labour were poor at predicting GBS carriage. Almost 1 in 5 women who had no known risk factors in fact carried GBS. Many GBS carriers were falsely given a negative result from a standard test. *Since the presentation, Prof Efstratiou has confirmed to us that the ECM test is not routinely available from PHE laboratories. "It is extremely important to have a very sensitive and also a Standardised Microbiological Screening Test. Currently Public Health England (PHE) offers a standard operating protocol called B58, and this is the UK Standard [...]
Dr Gopal Rao said that before the screening programme was put in place in late February 2014, the Trust had for several years experienced substantially higher levels of invasive GBS than the national rate: Approximately 5000 babies per year are born at Northwick Park Hospital Despite using a risk based IAP protocol, the invasive EOGBS rate was 0.88/1000 live births per year over the four years (2008-2012) twice the national rate (0.4/1000 live births) In 2013, the EOGBS rate was 1.65 per thousand live births; five out of the eight affected babies did not have maternal risk factors Between 2008-13, the LOGBS rate was 0.36/1000 and the maternal bacteraemia rate 0.95/1000. "Something is not working for us, [...]