GROUP B STREP TEST for Newborns... does it exist???

[ClassicCarSymptom]

Hi. I'm a newbie finding my way around MN.
I've bn treated with anti-b's in all my pregnancies due to GBS being detected in my first. I never make it in time for IV AB's during labour and so we have to stay in for baby to have AB's thru a cannular. Is there any way they can test a newborn for GBS... and if so how long does it take for such a test to yield results?? Or is there no such thing??! It's probably just my brain doing overtime on this GBS thing as a positive test over ten years ago dictates what happens now as when I asked my consultant for a test this time round her response without even looking at me was 'if you saw how ill babies can get you wouldn't be worrying about antibiotics'! I only want to understand things more fully so felt I have the right to ask questions.... but she clearly didn't feel the same way!
TIA!

[SomeSunnySunday]

They could do a blood test in a newborn for GBS, but as it doesn't always manifest straight away I'm not sure if it would always pick it up? And I doubt that any hospital would be willing to do this routinely for a well baby (although if they are prepared to give IV antibiotics maybe they would?). I thought they'd just keep the baby in for monitoring rather than proactive treatment? My DS1 had a neonatal GBS infection, and yes, he was very ill (but thankfully recovered fully), and with DS2 I think that the plan was antibiotics in labour, then monitoring the baby (although in the end I had an elective c-section so it was less relevant).

Definitely ask the question again, you've a right to understand. Group B Strep Support may also be able to advise.

[apermanentheadache]

I have also been GBS positive at the end of both of my pregnancies. With my first I had AB antibiotics but my baby didn't. With my second there was no time for AB antibiotic so we just had to stay in for 24 hours and DS had to have hourly or two-hourly obs done. No AV antibiotics for him.

Not helpful of the consultant to say that stuff about 'knowing how ill babies with GBS infection can get'. Obviously that's right, but I can fully understand you don't necessarily want to give ABs if there's an alternative.

[sallysparrow157]

When they put the cannula in to give the antibiotics, they will generally take some blood tests - a blood culture and some infection markers. The infection markers come back within a few hours and give a suggestion of whether or not there is an infection, but the blood culture is the only test that will tell for certain if the baby has group b strep or not. The culture test basically grows any bacteria that's in the blood, generally gp b strep grows relatively quickly and if the baby has an infection there will be a positive result within 24 hours but it takes 48 hours for a definitive result to come back. So we treat until there is a definite negative result.

[sallysparrow157]

If the infection markers came back high or the culture was positive the baby would need treatment for longer. In some hospitals, if there is only one risk factor for gbs (previous infection is one risk factor, others include fever in baby or mum, high heart rate in baby or mum, waters having gone several hours before birth) they will be happy to observe baby for 24 hours and only treat if there are any concers, you could ask for this but tbh if it was me I would rather the baby had the antibiotics

[ClassicCarSymptom]

Thank you all very much for ur replies... I really do appreciate that u even took the time to share ur knowledge and experiences (unlike my consultant!).
This has definitely given me food for thought and made the picture that bit more clearer.

[amy246]

As well as blood cultures they can do swabs from various parts of your baby. Common swabs are umbilical, nose, ear etc. the lab can then grow the bacteria from these swabs to see if your baby is carrying this bacteria. It takes a couple of days for results. If you're worried just ask if they can do these tests and they probably will.

[ClassicCarSymptom]

Many thanks for the additional info! I'm feeling inclined to just stick with baby having the AB's (never having made it in time for me to have the IV AB's).... all my DC's have allergies and last DC's was the worst we've dealt with so far, many people seem to put it down to the AB's. But when you run the risk of a possibly fatal infection you don't have much choice but to go for the lesser of the 2 outcomes...

[sandberry]

Current RCOG guidance would be not to treat at all if you haven't tested positive in this pregnancy and your previous baby didn't have GBS disease. The risk is so minimal (0.9/1000 versus 0.5/1000 for any random baby)

If your previous baby did have GBS disease then 24 hours surveillance is needed with antibiotic treatment up to parents and attending physician certainly not mandated.

If you have tested positive in this pregnancy then antibiotic treatment would be appropriate.

[ClassicCarSymptom]

Hi, many thanks for that information. I only wish my consultant was familiar with it/ act upon it. She's not at all interested in retesting me even though last positive test was with DC1 over ten years ago.... I found in my labour notes section that she's already written instructions for the IV AB's and active management of 3rd stage without ANY discussion with me!!! I'm seriously annoyed at such total lack of professionalism... and when you sound as if you know what you're talking about, some, like her, feel theatened and become even more indignant!

I need a cuppa and some chocolate...

[fasterthanthewind]

i had a GBS+ result between DC2 and 3 and just didn't tell anyone - they didn't ask, I didn't tell. No desire to stuff a healthy baby full of abs on the off-chance. A recent New Scientist had a fascinating article about the long-term effects of abs, on so many different aspects of health (diabetes, as well as allergies).

[ClassicCarSymptom]

Thanks for reply fasterthanthewind... any chance of a link to that article?

[rallytog1]

My dd was strongly (and correctly) suspected of having a strep infection when she was born. It was confirmed by a lumbar puncture done when she was about 30 mins old.

I was still in theatre but my dh was with her while they did it, and it is certainly something you would not want to put a newborn through if you didn't have to. He found it absolutely heartbreaking. If that's the alternative to precautionary abs, I'd take the abs any day. If course there may be other alternatives, but I'm not sure what they are.

[livingzuid]

My 3 week old had strep B too and was detected 24 hours after I gave birth. She nearly died but fortunately was sleeping with the nurses and not me who spotted it and sent her straight to icu. She was incredibly ill and it broke my heart to see her suffering so much and for them searching for a good place for an iv, having to give a newborn an epidural (which is awful) etc. She was on a variety of antibiotics until they isolated which bacteria it was and were able to provide targeted drugs (penicillin in this case). This was for twelve days and then she came home happy and infection free.

They take a blood test to see whether there is an infection present and also an epidural to look at the white blood cells and to grow a culture. They treated it as suspected meningitis at first which was beyond terrifying and in a way a relief to hear it was 'just' Strep B and easily treated with penicillin. It took two days to get the confirmation of the type of bacteria as they have to grow the culture first so you won't know what it is at the beginning. Hence why they treat them as a meningitis case so heaven forbid if the culture does come back as that they have started treatment hopefully early enough.

Your consultant is correct, you do not want to see your baby go through that and sit on intensive care for days with your heart in your mouth.

I completely understand that you don't want your baby to receive antibiotics so early but if it means he or she won't contract this horrendous infection then it is well worth it. Strep B is easily treated thank goodness but it can kill. I am sorry to sound so alarmist but having watched my own child go through that I couldn't bear to see anyone else have to go through it if it could be avoided with a simple course of antibiotics.

[ClassicCarSymptom]

I really appreciate that you have both shared your stories and am so happy for you that the outcomes were good. Your right I can't imagine some of the things you or your DP's have had to suffer/witness.

My main grumble tbh is her attitude of not even giving an explanation other than 'if I saw how ill babies become'.... I've had more info on this thread than anyone has cared to provide before even though it's THEIR job! I'd imagine all consultants want to work on the premise of removing all risks and I do fully appreciate that... but I don't agree with simply being dictated too and would have been a lot more at ease if she made me feel part of the discussion with some detailed explanation rather than me having to have one on MN!!

[livingzuid]

clsssic this is very true, they just dispense orders without the parent being able to make an informed decision and I can imagine how frustrating that must have been. I had never heard of Strep B until I was told that was what my baby had. I am in the Netherlands and granted there is a language barrier, but I was livd to find out it could have been avoided with a C-Section. I had a long labour and assisted delivery (cone) and meconium, and one thing I did not know and maybe you haven't been told this either but the chances of the baby contracting the bugs such as this or meningitis are greatly increased by both factors. I was so angry when I heard, but there is such an obsession here with natural birth at all costs I had to be seen to do everything possible, including my poor baby getting stuck trying to come out, before they would have done a c section.

I do hope you get some more info. Personally I would choose the antibiotics over any risk of the baby contracting the bug as you just never know how labour will turn out. Good luck :)

[livingzuid]

I should also add that with the bloodtest that they do to see if there is an infection, it is just to see whether there are infection markers in the blood which a pp also said. They actually use physical symptoms as an indicator of how the baby is doing as the infection progresses/retreats faster than what they can see in the blood. The main indication of a problem is fever (as I understand it any fever is bad in a newborn), along with marbly skin that begins in the hands and feet/extremeties of the body (although babies can just have this naturally) and when you do the glass test or press on it the indentation you make doesn't disappear if that makes sense. The baby is quiet, not alert and crying frequently but weakly. I think there is something on the NHS website about it. I know far more about this illness than I like!

[rallytog1]

living - a c section is no guarantee that your baby won't have strep I'm afraid. I had a cs but my dd still had it.

You're right though - I think there is a default assumption that everyone will just accept what they're told. Medical professionals do need to realise that people need evidence and an understanding of the options.

[livingzuid]

rally that's interesting - I was told by a nurse that the C section would have prevented it which must have just been in my case, but obviously not! It was a lot of conversing in Dutch, some in English, with a very tired DH trying to translate at the time and in general it was a nightmare. I felt so confused and scared and felt as if I had very little choice in what was going on in terms of treatment options, labour, etc. The care was excellent but I would have preferred to have more input. It can't be fun for the OP to be dictated to with regards what will happen to her and her child.

Sorry you had to go through that too with your dd.

[fasterthanthewind]

It isn't this one - I can't find it - but this may be related?

www.newscientist.com/article/mg21328583.700-antibiotics-may-make-you-fat.html

will keep digging (lots of NS is password protected, I fear...)

[fasterthanthewind]

Maybe it's this one? I don't remember it being a book review tho (you can read all this one - its about antibiotics as (metaphorically!) WMDs)

www.newscientist.com/article/mg22229701.000-why-antibiotics-are-wmds-to-our-bodies-microbes.html#.U6l4xV4k_1o

[livingzuid]

faster none of your articles alter the fact that Strep B can and does kill. I live in a country that has virtually no MRSA in hospitals, is very big on non intervention and will never prescribe antibiotics unless it is a last resort. So for them to give my daughter penicillin meant she needed it.

There is a reason that women who test positive for Strep B have their babies given the antibiotics. I believe the issue for the OP was the consultant not explaining infection potential and the pros and cons of the treatment to her in the first place.

I would be the first to say that medicine can be dished out like sweets with little thought as to long term impact. But antibiotics still play a valuable role in prevention of aggressive infections such as Strep B. I hope you, or anyone else for that matter, never have to see your child go through such a thing, and I for one am grateful that such treatment exists. The alternative is unthinkable.

[ClassicCarSymptom]

Thank you for all the info... I haven't checked out the info yet but will be having a read.

What's coming out of this discussion for me is the frustration of not being given the knowledge we need to understand all the ramifications of this widespread and so very sadly sometimes fatal illness. I know I would have little choice but to want to play it safe... and at the same time it's important for all medics to follow the SAME standard guidelines as someone posted above re RCOG. By failing to stay updated and following guidelines patients will often be left in the dark and could potentially be given the wrong information, eg. you can't pass on GBS if you have a c-section?!

Not look forward to seeing my consultant again though...!

[divingoffthebalcony]

I tested positive for GBS when I was pregnant, and had one lot of IV antibiotics in labour.

The midwife caring for me said that IV antibiotics for the baby was hospital policy... BUT I didn't need to consent to them. I could instead stay in hospital for 24 hours so my baby's temp could be monitored (which was no problem, I'd had a third degree tear and was going nowhere!). DD was fine.

Knowing that the likelihood of transmission is small (but not zero, of course) I felt comfortable waiting it out.

[fasterthanthewind]

Strep B infection is terrible, really terrible - have friends whose children had it. And OF COURSE if a child is ill, and abs can make a difference, nobody in their right mind wouldn't give them! Thank God, for your child's sake, and the sake of others, that we have abs.

BUT I think the article is making a different point: we haven't understood the long-term effects of drugs that are often given as (perhaps unnecessary) prophylactics.

I don't know anything about the numbers, but say you were told that there was - a 1% chance of your baby getting Strep B, reduced to almost nothing (but not nothing if they had abs)

• a 25% chance of them developing metabolic disorders (from diabetes to obesity) if they did take the abs
  

• what would your decision be then? If your child actually started developing symptoms OF COURSE your concern is for their immediate health, and you wouldn't think twice about the long-term risk. But as to automatically giving abs on spec - I think it would become a much more carefully-thought about decision (whichever decision was reached).

[fasterthanthewind]

sorry, that was for zuid