Health

Saturday 30 August 2014

'It was touch and go for my newborn son as silent killer GBS struck'

Although symptomless and harmless to pregnant mums, a common bacteria infection can be lethal for babies if undetected. Luckily for Jen O'Reilly and Conor, doctors caught it in time, writes Shane Cochrane

Mum-of-two Jen O’Reilly with son Conor who was struck by Group B Streptococcus, and baby Emma

After a difficult labour that had lasted through the night, Jen O'Reilly gave birth to her first child, Conor. Though he was a little jaundiced, and had a small cut on his head, he seemed fine. But Jen wasn't.

"Immediately after giving birth, I started to feel unwell," she says. "I had a high temperature. I was shaky and feeling cold. Then I got sick. They said it was a normal reaction, given what I had been through."

It wasn't a normal reaction. But getting sick saved her newborn son's life.

"Later, one of the doctors said that we were lucky that I had developed a temperature during labour. That's what prompted them to test Conor's blood. And if they hadn't tested his blood ... I don't know where we'd be."

Conor had septicaemia, caused by exposure to Group B streptococcus bacteria during his birth.

"From what I remember, it was briefly explained to us. But we didn't know what it was, or how he'd got it. I had never heard of it before. I couldn't understand how it had come about. Was it an STI? Was it me? Did I do something wrong? That was really upsetting."

But Jen had done nothing wrong.

Group B streptococcus (GBS) bacteria are found in the digestive system of approximately 30pc of the adult population.

Carrying the bacteria is symptomless and – for the most part – harmless to adults; but without a test, it's impossible to know if you're a carrier.

"GBS bacteria normally live harmlessly in the bowel and also in the vagina and throat, but it's not clear why some people carry it and others don't," says Caroline O'Connor, medical information officer at the Meningitis Research Foundation in Dublin.

"However, carriage rates do vary according to age and race, and can even vary throughout a pregnancy. Because the reasons for carrying GBS are relatively unknown, there are currently no real measures to prevent someone being a carrier."

About 21pc of pregnant women carry the GBS bacteria in their vagina. And while it's symptomless and harmless to the mother-to-be, it can be incredibly dangerous for the new-born.

During birth, newborns can be exposed to the bacteria. Their immature immune systems leave them vulnerable to infections, and premature babies are particularly at risk. GBS bacteria can get into the blood, causing septicaemia; or into the lungs, causing pneumonia.

When the infection occurs during birth, or in the hours and days after birth, it's known as early-onset GBS infection.

However, a GBS infection can occur up to three months after birth. This is a late-onset GBS infection and it can cause meningitis. In many cases, babies can be left with a permanent disability. In the worst cases, meningitis can be fatal.

Jen was very fortunate that the doctors recognised the symptoms and acted quickly. But Conor was still very ill.

"They had taken further blood; the level of infection had increased. It really was serious," she says. "At the time, it was very touch and go. Conor had become very ill, very quickly. The doctors told me that some babies have symptoms, but you wouldn't have known Conor was ill. He was jaundiced, but a lot of babies are jaundiced."

Conor was given antibiotics, intravenously, twice a day, and his blood closely monitored. It would be two weeks before Jen would hear the news she'd been praying for.

"His blood test came back clear. There was no sign of infection."

It's important to note that GBS infection rates are quite low. A study published in the 'Lancet' in 2004 put the infection rate at six cases per 10,000 live births in Ireland.

However, given the potential for fatalities and long-term disabilities, organisations like the Meningitis Research Foundation and Group B Strep Support believe all pregnant women should be routinely screened for GBS, and treated with antibiotics during labour.

"The current procedure in the UK and Ireland means that only mothers with certain risk factors – such as a previous neonatal infection or a fever of more than 38°C during labour – will receive antibiotics during labour," says Caroline O'Connor.

While there are some variations, hospitals in Ireland tend to follow the UK's risk-based strategy and the guidelines devised by the Royal College of Obstetricians and Gynaecologists.

But Group B Strep Support believe that this risk-based strategy is too complex and has not been effective. More worryingly, they believe that medical practitioners are not following it correctly.

In a 2013 study of UK neonatal units, it was discovered that only 21pc of women who exhibited the relevant risk factors during labour actually received the appropriate antibiotics.

The researchers concluded that up to 80pc of infant infections could have been prevented had the guidelines been followed correctly.

Additionally, according to Group B Strep Support, one third of GBS infected babies are born to women "with no recognised risk factors".

The organisation believes that screening is the best way to prevent GBS infections in babies as it actually identifies those women who are carriers of the bacteria. It's a belief shared by the Meningitis Research Foundation.

"We fully support the introduction of screening for pregnant women," says Caroline O'Connor. "Group B Strep Support are very active in their efforts to lobby for widespread screening for mothers-to-be, and we fully support their efforts."

Countries that have already adopted screening programmes have seen phenomenal drops in the numbers of GBS infections. In the USA they saw an 80pc drop in the number of cases; in Australia they had an 82pc drop; and in Spain the number of GBS infections fell by an incredible 86pc.

The test used to screen pregnant women for GBS is also inexpensive and easy and safe to perform. It's done at 35-37 weeks and involves taking swabs from the vagina and rectum. The swabs are sent to a laboratory and tested for the presence of GBS bacteria. The results are normally available in about three days.

But, if screening is such an effective way to deal with GBS, why hasn't it been introduced?

As recently as 2012, despite examining all the evidence, the UK National Screening Committee failed to recommend the introduction of a screening programme for GBS.

Normally cost is the prohibiting factor in these issues, but a 2012 UK government sponsored study found that an effective screening system could save the UK £67m per year.

So, what's the problem?

"There are concerns over the use of antibiotics in pregnancy and their effects on both mother and baby," says Caroline.

"There are concerns about the overuse of antibiotics and the development of antibiotic resistance in bacteria.

"There's also some debate over how much impact it would have on late-onset disease."

"Despite this, we know that antibiotics during labour do have an effect on the incidence of early-onset disease. This is why we would support the introduction of a screening programme to help prevent more of these cases."

The lack of a screening programme isn't the only concern; a lack of awareness of GBS infections is also a major issue.

"The biggest problem for us was that we just didn't have a clue about what was going on, and we were very scared," says Jen.

"We were just so uninformed. That was the worst part – not knowing."

According to Group B Strep Support, very few women are made aware of GBS during pregnancy, and even fewer are offered a test.

They also found that awareness of GBS among health professionals was poor.

Currently, the Meningitis Research Foundation is funding a study of the treatment of GBS in infants under three months old, with a view to addressing some of these issues.

"The aims of the study are to improve and standardise treatment guidelines, raise awareness of the disease among health professionals and promote better use of antibiotics during labour where the risk factors are presented," says Caroline.

With her second pregnancy, Jen made sure that all the health professionals involved were aware of GBS, and her increased risk of having a GBS infected baby.

"One of the doctors actually wrote GBS in big letters on the front of my file," she laughs.

On July 20, 2013, Jen went into labour. She was given antibiotics intravenously as soon as she arrived at the hospital. And, 20 minutes after she was born, baby Emma was taken away and started on a course of intravenous antibiotics. But all was well.

Jen is very active in raising awareness with other mothers-to-be, though it's not always easy. "It's not something that anyone seems to know about. And it's hard to explain because no one knows about it. I feel like telling people, 'I'm not diseased. I don't cause infections. It's not something that was my fault'.

"And it's hard to tell people without scaring them. But, at the same time, a lot of people believe that, if they haven't heard of it then it can't be that important."

But, as Jen and many other mothers know, it really is that important.

Further information about Group B streptococcus, meningitis and septicaemia can be found on the Meningitis Research Foundation website (www.meningitis.org). You can also talk to someone at the charity by calling their Freefone Helpline (1800 41 33 44 or 080 8800 3344 in Northern Ireland).

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