Guidelines

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Guidelines 2017-04-18T17:02:22+00:00

We want to see the National guidelines for preventing group B Strep infections in newborn babies updated, to reverse the rising incidence of what is a largely preventable disease. We are constantly campaigning to medical governing bodies for changes to be implemented.

Here you can download and read some of the guidelines from the UK and abroad (this page is updated as guidelines are reviewed).

UK Guidelines

National Institute for Health & Care Excellence

Antibiotics for the prevention and treatment of early-onset neonatal infection (2012) – This focuses on the use of antibiotics for the prevention and treatment of early-onset bacterial infection (within 72 hours of birth), including those caused by group B Strep. Recommends all pregnant women found to carry group B Strep during their current pregnancy should be routinely offered intravenous antibiotics in labour. In January 2017, a decision was taken to update this guideline.

Antibiotics for neonatal infection Quality Standard (2014) – This covers the use of antibiotics to prevent and treat infection in newborn babies (both term and preterm) from birth to 28 days in primary (including community) and secondary care. It includes antibiotics that are given to newborn babies or to mothers during intrapartum care to prevent neonatal infection (antibiotic prophylaxis). Recommends all pregnant women found to carry group B Strep during their current pregnancy should be routinely offered intravenous antibiotics in labour.

Antenatal care for uncomplicated pregnancies (issued 2003, reviewed 2008, 2011 and 2016) The 2008 and 2011 reviews did not update the sections relating to group B Strep in the light of new evidence since 2003, despite requests by a number of stakeholders. In January 2017, a decision was taken to update this guideline.

Inducing labour. Contains no mention of babies born to women carrying group B Strep. In January 2017, a decision was taken to update this guideline.

Intrapartum care for healthy women and babies. Excludes “additional care for women with known or suspected infectious co-morbidities such as group B streptococcus” Published December 2014, guidance on measuring fetal heart rate as part of initial assessment and on monitoring during labour updated February 2017.

Intrapartum care for high risk women. Excludes women ‘infected with’ group B Strep. Expected publication November 2017.

Postnatal care up to 8 weeks after birth. Contains no mention of babies born to women carrying group B Strep. In January 2017, a decision was taken to update this guideline.

Bacterial meningitis and meningococcal septicaemia. The management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care (ie not in a neonatal unit) Next review 2018.

Urinary tract infection in under 16s: diagnosis and management Review started July 2016. Publication expected July 2017.

The Cepheid Xpert GBS test for intrapartum detection of Group B Streptococcus – Medtech innovation briefing. Published April 2015.

Royal College of Obstetricians & Gynaecologists

Clinical Green Top Guideline No 36 Prevention of early onset neonatal GBS disease (issued 2003, updated 2012). Currently under review, expected publication summer 2017. (PDF)

RCOG Information for Patients – Preventing group B Streptococcus (GBS) infection in newborn babies: information for you (issued 2006, updated 2007, 2014) (PDF)

In 2013/4, the RCOG conducted an audit into UK group B Strep prevention policies.

The first report 2015 RCOG Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK shows excellent adherence of policies of UK maternity units to recommending the offer antibiotics in labour for women with their key recognised ‘risk factors’ but also for other risk factors, such as carrying group B Strep in a previous pregnancy. It shows that more than half of units test some or all pregnant women for group B Strep carriage – against national guidance – but most are not using the ECM (enriched culture medium) test recommended for the purpose.

The second report 2016 RCOG Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK calls for national guidelines to be updated. It shows that almost 40% of Midwife Led Units accept women known to carry GBS that pregnancy, more in alongside (rather than stand-alone) MLUs. It also shows that few maternity unit policies (6.5%) recommend routine testing of pregnant women while reported practice in more than half of units do – clearly there are many occasions when health professionals support, on a case-by-case basis, mothers’ finding out whether they are carrying GBS.

2007 RCOG Audit on the prevention of neonatal Group B Streptococcal disease this reports practice in England, Scotland,Wales and Northern Ireland in UK Obstetric Units against the RCOG’s guideline for the Prevention of Early-onset Neonatal Group B Streptococcal Disease. A new audit is underway in 2014. For more information about the new audit, click here.

Preterm PROM in group B Strep positive woman – Query Bank Statement

Public Health England

Public Health England’s UK Standards for Microbiology Investigations B 58 Detection of Carriage of Group B Streptococci. Issue 3. (issued 2006, updated 2014, 2015) – testing specifically for group B Strep carriage

Public Health England’s UK Standards for Microbiology Investigations B 28 Investigation of Genital Tract and Associated Specimens (issued 2003, updated 2014) – non-specific testing. Page 14 states, “According to local protocol, patients judged at high risk for the development of group B streptococcal infection may be screened for carriage. Optimum yield will be achieved by selective/enrichment procedures applied to swabs obtained from the vagina and the anorectum”

Public Health England’s UK Standards for Microbiology Investigations SMI B 41: Investigation of urine (issued 2014, updated 2016) – testing of urine for the presence of microorganisms.

Group B Strep Page including epidemiological data (Next update on England, Wales & Northern Ireland incidence due end November 2017).

Data Series from PHE & predecessors for England, Wales & Northern Ireland on the incidence of GBS bacteraemia from 2001 onwards. Both the rate per 1,000 live births and the number of these infections in babies aged 0-6 days in England, Wales & Northern Ireland have risen since the RCOG introduced their risk-based guidelines in 2003.

UK National Screening Committee

National Screening Committee Policy Position on antenatal group B Strep screening was last reviewed during 2016. They decided against the introduction of routine antenatal screening of all pregnant women for group B Strep. The next review is due in 2019/20.

During the public consultation, 65 written responses were received. All of the 57 individual members of the public were in favour of screening. Three of the 7 national organisations clearly favoured screening. The UK NSC used their modelling study to support their recommendation, despite it calculating only 351 early onset GBS infections in the UK under a risk based prevention strategy, compared with 450 reported through the recent BPSU enhanced surveillance study. It was a hugely disappointing decision and one against the opinions of the overwhelming majority who took the time to comment.

International Guidelines

Australia & New Zealand The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2003, updated 2012, to be reviewed 2019.

Belgium – Prevention of perinatal group B Streptococcal infections. Guidelines from the Belgian Health Council, 2003

Canada – The prevention of early-onset neonatal group B Streptococcal disease. Society of Obstetricians and Gynaecologists of Canada, September 2004.

Czech Republic – Měchurová A, Vlk R, Unzeitig V (2007) Doporučené postupy V perinatologii 3. doporučený postup při diagnostice a léčbě streptokoků skupiny B v těhotenství a za porodu. Moderní Gynekologii Porodnictví 16:č 1- s A

France – ANAES. Agence Nationale d`Accreditation et d`Evaluation en Sante (2001) Prévention anténatale du risque infectieux bactérien néonatal précoce.

Germany – Prophylaxis against neonatal sepsis (early onset) by group B Streptococci (2008)

Hong Kong – The Hong Kong Hospital Authority & the Department of Heath 2012

Italy – Societa Italiana di Medicina Perinatale (1996) Proposta: linee-guiada per la prevenzione delle infezioni perinatali da streptococo β-emolitico di gruppo B. Boll Soc Ital Med Perinatale 1:21-24

Netherlands – Nederlandse Vereniging voor Obstetrie en Gynaecologie. NVGO: Preventie van neonatale groep-B-streptokokkenziekte (Gbs-Ziekte). Versie 2.0. (2008)

Poland – Kotarski J, Heczko PB, Lauterbach R, Niemiec T, Leszczyńska-Gorzelak B (2008) Rekomendacje Polskiego Towarzystwa Ginekologicznego dotyczàce wykrywania nosicielstwa paciorkowców grupy B (GBS) u kobiet w cià˝y i zapobiegania zaka˝eniom u noworodków. Ginekol Pol 79:221-223

United States of America – Centers for Disease Control: Prevention of Perinatal Group B Streptococcal Disease, Revised Guidelines 2010, Standard Operating Procedures for 2010 Guidelines for Laboratorians and more resources on the CDC’s GBS page

Spain 

[Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document.] [Article in Spanish] Alós Cortés JI, Andreu Domingo A, Arribas Mir L, Cabero Roura L, de Cueto López M, López Sastre J, Melchor Marcos JC, Puertas Prieto A, de la Rosa Fraile M, Salcedo Abizanda S, Sánchez Luna M, Sanchez Pérez MJ, Torrejon Cardoso R. Enferm Infecc Microbiol Clin. 2012 Jun 1.

Switzerland – Surbek D, Gross A, Seydoux J, Honegger C, Irion O, Drack G (2008) Prévention de l’infection néonatale à Streptocoques du groupe B à début précoce. (2008).