When newborn babies die of infection, the leading cause is the group B streptococcus. Paediatricians from Newcastle carried out a survey in the Northern Region in which they looked for risk factors.1 For each infected baby in a neonatal unit, they selected four controls for comparison. Of 37 such infants, five died. In addition, three stillborn babies were also infected.
Prematurity (less than 34 weeks) was a significant risk factor (as infection can set off early labour). Many of the babies were probably infected in the womb. Both prolonged rupture of membranes (13.5 hours before delivery) and prelabour membrane rupture (26.7 hours before delivery) were risk factors. Nearly 80 per cent – 23 of 29 women – were in hospital long enough before delivery to have been given antibiotics at least four hours beforehand, as recommended by the Public Health Laboratory Service as it has been shown to reduce the chances of high-risk babies getting an infection. Using this policy would mean that 23 of the control women (whose babies were not infected) would also have been treated.
The authors say that current guidelines might prevent or reduce damage in three-quarters of all cases of infection, but with the cost of giving antibiotics to 16 per cent of all women in labour.
We receive a steady trickle of serious complaints from women who have lost babies who knew they were carriers of group B streptococci from a previous pregnancy, and yet had not had the antibiotic cover they should have had or had asked for. Clearly, practices can be very sloppy. However, we also have many calls from women with ruptured membranes who are reluctant to go into hospital, fearing the greater risk of interference and infection there, including unnecessary vaginal examination. We note that only seven of the 37 women had fever in labour, so absence of fever cannot be taken as absence of infection (though fever in labour was 10 times more common in infected cases than in the controls). What about preventative antibiotic cover at home for those women who want it?
The authors quite rightly raise the question of the increase of antibiotic- resistant germs with overuse of these drugs. And we, too, are concerned that giving women broad-spectrum antibiotics in labour could increase the incidence of necrotising enterocolitis (a serious and often fatal gut disorder) in babies2.
- Oddie S et al. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ, 2002; 325: 308-11
- Kenyon S et al. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE randomised trial. Lancet, 2001; 357: 979-88