Managing Group B Strep

By Cecelia Cancellaro

Dawn Fox of Mount Juliet, Tenn. had a 3-month-old daughter when she became pregnant again in 1996 at the age of 26. Her second pregnancy, like her first, was uneventful and without complication. When she went into labor, during her 39th week, all of that changed.

Fox was running a high fever and her baby began to show signs of distress. An emergency Cesarean was performed and soon after the delivery, it became clear that her baby girl, Ellison, was sick. She was immediately transported to the neonatal intensive care unit of a nearby hospital where tests revealed that she was infected with the Group B streptococcus bacteria and suffering from sepsis (a blood infection) and pneumonia. "We were told that our daughter was 'in grave condition,'" says Fox. "That phrase haunts me to this day."

What Is It?
According to the Centers for Disease Control (CDC), Group B streptococcus (GBS) is a type of bacteria that can cause illness in newborn babies, pregnant women, the elderly and adults with other illnesses, such as diabetes or liver disease. Many adults carry GBS in their bodies without ever becoming ill, but pregnant women who carry GBS in their rectum or vagina (one out of every four or five are carriers, according to CDC estimates) run the risk of exposing their babies to the bacteria during labor and delivery.

GBS is the most common cause of life-threatening infections in newborns, including sepsis and meningitis, as well as the frequent cause of newborn pneumonia. In pregnant women, GBS can cause bladder infections, womb infections and stillbirth. CDC figures suggest that one out of every 20 babies with GBS disease will die from the infection and those that survive may experience a host of long-term problems.

After Ellison's birth, Fox was horrified to learn that simple screening and prevention measures existed that could have prevented her daughter's severe illness. "I knew nothing about GBS at the time," she says. "My doctor never said a word to me because I wasn't considered high-risk. My daughter endured weeks of intrusive treatment while we waited and wondered if we were going to lose her. She is now a healthy and happy 5-year-old, and for that we are grateful, but it has taken me a very long time to come to terms with what happened and to get over the anger associated with the experience."

What Can You Do About It?
In 1996, the same year that Fox gave birth to Ellison, the CDC issued guidelines for GBS prevention and screening. According to Dr. Traci Kurtzer, an obstetrician-gynecologist with ENH Medical Group in Deerfield, Ill., "The CDC guidelines recommend two strategies for preventing GBS. The first way is for practitioners to give every pregnant woman a genital and rectal culture at 35 to 37 weeks gestation and to administer prophylactic antibiotic therapy based on the results.

"The second way is to base prophylactic antibiotic treatment on risk factors alone. These factors include a history of previous infant GBS infection, a history of GBS related urinary tract infection, premature labor or rupture of membranes, prolonged rupture of membranes (greater than 18 hours) or a maternal fever higher than 100.4 degrees during labor."

Deciding which approach to use is up to the individual practitioner and is often based on the prevalence of GBS in their particular practice as well as the accuracy of GBS culturing. Dr. Kurtzer recommends that women talk to their physician to determine which strategy she or he employs and why.

For many whose lives have been affected by GBS, leaving this decision up to physicians is not a desirable option. Shelene and Chris Keith of Ventura, Calif. almost lost their newborn son, Jesse, to GBS disease in 1997. Jesse was pronounced healthy and sent home from the hospital 36 hours after his birth. Just a few hours later, the Keiths were rushing him back to the nearest emergency room where he was diagnosed with spinal meningitis and sepsis due to GBS. "The doctor said he probably wouldn't live through the night," says Shelene Keith. "We got on our knees and prayed the prayer of a lifetime that our little baby would be healed."

Their prayers were answered and Jesse did live through the excruciating ordeal, but he's had to endure three brain surgeries in the same number of years and he retains a permanent shunt in his brain to drain excess fluids caused by hydrocephalus (which is a side effect of meningitis). Since his birth, the Keiths have devoted themselves to spreading the word about the dangers of GBS. Their foundation, The Jesse Cause, can be reached at thejessecause@iolwest.com.

Paige Judy, 28, of American Fork, Utah, echoes this sentiment. In 1998 she lost her newborn daughter, Samantha, to GBS disease. Judy was not tested for GBS during her pregnancy. "Samantha's death was so preventable and it has left a hole in my life that will never be filled,” she says. “I've had two other children since I lost Samantha and our family pictures will always be missing someone. I just want to make sure that other women know that they need to be tested for GBS."

Lisa Porter of Jacksonville, Fla. has been involved in GBS education ever since her now healthy daughter Kaley was born with GBS sepsis eight years ago. A former member of the board of directors of the Group B Strep Association, Porter now provides telephone and online support (grpbstrep@hotmail.com) to women who are seeking information about GBS.

The Good News
Although there is still a great deal of room for improvement, Porter feels that some progress has been made. "In the nearly eight years of doing this, I've been pleased to see a huge drop in the number of calls/e-mails from moms who've had bad outcomes and a huge increase in moms who have tested positive and just want information."

Dr. Carol J. Baker, professor of pediatrics, molecular virology and microbiology at Baylor College of Medicine in Houston, Texas and one of the leading GBS researchers in the country, confirms this good news.

"The number of cases of early-onset GBS sepsis, meningitis or pneumonia in newborns less than seven days of age has dropped by 70 percent between 1993 and 1999,” she says. “While this decrease is impressive, two things are needed to further reduce this number. First, a screening strategy must be employed since the risk-based strategy is missing up to 50 percent of GBS cases. Additionally, whatever strategy is chosen, the preventative antibiotic by vein should be given as soon as possible after a pregnant woman who has been identified as a GBS carrier is admitted to the hospital for delivery (and optimally at least four hours before delivery)."

In the meantime, GBS parents like Shelene and Chris Keith will continue their fight for more strident standards. "We are working hard for universal testing," says Shelene Keith. "We are determined to stop other parents and babies from experiencing the pain that we have."

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About the Author: Cecelia A. Cancellaro is the author of Pregnancy Stories: Real Women Share the Joys, Fears, Thrills and Anxieties of Pregnancy from Conception to Birth (2001). You can visit her website at www.pregnancystories.net.