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UK Guidelines2018-06-27T16:59:31+00:00

UK Guidelines

We want the UK’s national guidelines for preventing group B Strep infections in newborn babies to be updated, to reverse the rising incidence of what is largely preventable disease. We campaign to medical governing bodies for changes to be implemented.

From this page, you can download the most recent UK guidelines relevant to group B Strep (this page is updated as guidelines are reviewed).

UK Guidelines

Royal College of Obstetricians & Gynaecologists

Clinical Green Top Guideline No 36 Prevention of early onset neonatal GBS disease (issued 2003, updated 2012, 2017). (PDF) Group B Strep Support has produced a summary of these guidelines, including flowcharts of the key recommendations. 8-page summary. Flowcharts only.

Group B Strep (GBS) in pregnancy and newborn babies (issued 2017, jointly developed by the RCOG and GBSS)

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

Report 1: 2015 RCOG Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK showed excellent adherence of policies of UK maternity units to recommending the offer antibiotics in labour for women with their key recognised ‘risk factors’ plus other risk factors, such as carrying group B Strep in a previous pregnancy. It showed 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.

Report 2: 2016 RCOG Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK called for national guidelines to be updated. It showed almost 40% of Midwife Led Units accept women known to carry GBS that pregnancy, more in alongside (rather than stand-alone) MLUs. It also showed 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 reported 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.

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 – to be published 2020.

Inducing labour. Contains no mention of babies born to women carrying group B Strep. In January 2017, a decision was taken to update parts of this 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 March 2019.

Postnatal care up to 8 weeks after birth. Contains no mention of babies born to women carrying group B Strep. As of January 2018, this guideline is being updated.

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 Reviewed with minor changes in 2017. Next review 2019.

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

Public Health England

Public Health England’s UK Standards for Microbiology Investigations B 58 Detection of Carriage of Group B Streptococci (Streptococcus agalactiae). Issue 3.1. (issued 2006, updated 2014, 2015, 2018) – 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, 2017 – under review) – 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, 2017, 2018) – 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 2018).

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.