Group B Streptococcal Disease Neonatal

Key Messages

  • Neonatal Group B Strep is caused by the bacteria Group B Streptococcus (Streptococcus agalactiae) which is a common bacteria found in female genital and gastrointestinal tracts.  

  • Can be transmitted to babies when they are delivered. 

  • Can cause multiple infections in the neonate including sepsis, meningitis, and pneumonia. 

  • Antibiotic prophylaxis prior to delivery for pregnant individuals who are known to be colonized can help decrease the incidence of severe disease. 

Introduction

Group B Streptococci (GBS) are gram positive cocci that grow in pairs and chains. They are commonly found in the gastrointestinal and genital tract. Normally this does not cause symptoms in people who are colonized with this organism. However, GBS can lead to significant disease in neonates who become infected during delivery. GBS can present in neonates as either early-onset disease which is usually within the first 7 days of life or late-onset disease which manifests after 1 week to 3 months of life. Early-onset disease is more often associated with respiratory complications and late-onset disease is more commonly associated with bacteremia and meningitis. Meningitis can lead to long term complications including neurodevelopmental impairments. 
Local Epidemiology

Risk factors for GBS infection in neonates includes maternal history of GBS colonization, inadequate antimicrobial prophylaxis, prolonged rupture of membranes (>18 hours), maternal fever during delivery, prematurity, and history of invasive GBS in previous infants. Increased rates of early-onset disease are also associated with maternal age <20 and patients who are Black. 

About 10-30% of women are colonized with GBS worldwide.

For more information on Neonatal GBS in Ontario, please refer to Public Health Ontario’s Group B Streptococcal Disease, Neonatal (Group B strep)website.  
Signs and Symptoms

Early onset disease presents with respiratory distress, apnea, shock, pneumonia and less often meningitis.

Late onset disease presents with symptoms of meningitis or sepsis including fever, lethargy, irritability, vomiting, and poor feeding. Babies may also have a bulging fontanelle. 
Diagnosis/Laboratory Testing

Isolation of organism from a sterile body fluid such as blood or CSF from culture or a positive nucleic acid amplification test (NAAT) from a sterile site.
Reporting Requirements

Confirmed and probable cases of invasive GBS disease in a newborn within the first 28 days of life are reportable to the local health unit under the Health Protection and Promotion Act and can be reported to OPH by the next business day by phone or fax.

Phone: 613-580-2424, extension 24224 and leave a detailed confidential message including your contact information; or fax 613-580-9640. 

Please see the OPH Health Care Professionals Reporting a communicable disease or event webpage for more information on how to report to public health.  
Management

The management of neonatal GBS disease includes intravenous antibiotics and supportive measures such as fluid resuscitation.
Prevention

Prenatal screening for GBS colonization is carried out by health care providers providing prenatal care. Intravenous antibiotics prior/during delivery are given to individuals who are colonized with GBS, and those who are at high risk of delivering an infected infant (premature delivery, intra-partum fever and prolonged rupture of membranes). The goal of the antibiotics is to stop the transmission of GBS to neonates and to decrease infection and mortality.
Patient Resources
Physician Resources

General Information

Clinical Guidelines 

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For more information, contact Ottawa Public Health at 613-580-6744.

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