We recently received a letter from Nicolene Strydom, mother of newborn baby Nathan, urging moms-to-be to get tested for strep-B. "I don't want anyone else to go through the pain my husband and I are going through," she says.
This is Nathan's story:
I had a perfectly normal pregnancy. I went to my gynaecologist for monthly check-ups and with every visit, everything seemed 100% fine. This was our first born. We were so excited to meet our little bundle of joy, Nathan.
On 13 March, I went into labour at 39 weeks at 5:30 in the morning. My husband took me to the private hospital. Nathan was born 16:22 that afternoon. He weighed 3.08kg – a perfectly healthy baby boy. We were discharged the next day, the doctor cleared us both for discharge.
Nathan then became very fussy and started to cry a lot. We could see that he was in pain and he struggled to feed. We took him back to the private hospital the next morning, 15 March. The paediatrician had a quick look at him and diagnosed him with colic.
I explained his symptoms to her: struggling to feed and sleep, making these funny screaming noises, curling his body into a ball, making funny faces because of the pain, making grunting noises, and he had a lot of dirty nappies. She confirmed it's all due to the colic. She sent us home with a script. We gave him his medicine as prescribed hoping he will get better. He did look a little better every time we gave him the pain medicine.
The morning of 17 March I nursed him and laid him down in his cradle at about 5am.
But when my husband and I woke up, we found him dead.
We rushed to the hospital, hoping they could still save him. On our way to the hospital I called his paediatrician on her emergency number; it went straight to voicemail, and I left a message. Till today I am still waiting for a call back from her…
We arrived at the hospital, the doctor tried to resuscitate him, but it was too late.
Group B Streptococcus
At first, we blamed ourselves thinking, “What did we do wrong?” The autopsy report then confirmed he died of neonatal meningitis caused by a Group B streptococcal (GBS) infection. I started doing research.
About 30% of pregnant women are carriers of Group B strep. This was the first time I ever heard of Group B strep. I did a great deal of research when I had to make the decision between a c-section or natural birth and not once did this pop up. This could've been prevented if they'd tested me at 37 weeks of pregnancy for the bacteria.
Women don't show any symptoms if they are carriers, it can only be confirmed through a swab test. If a woman tests positive for Group B strep, all they have to do is put her on an antibiotics drip during delivery that will prevent the bacteria from being transmitted to the baby.
I was never offered to be tested, neither was I informed about it, and nowhere did any research I did show that Group B Strep is a potential risk during birth. Believe me, if I'd known about it, I would've insisted on being tested.
The test is not a routine test during pregnancy in South Africa. If your gynaecologist does not inform you, you will never know about this.
I want to get the word out there and warn pregnant women of this. I feel all pregnant women must insist on this test at 37 weeks. Believe me, I don't want anyone else to go through the pain my husband and I are going through.
Nicolene Strydom, Nathan's mommy
- Also read: Antenatal tests week-by-week
Sr Burgie Irelands explained in an older edition of Your Baby magazine what strep-B is, how it affects your newborn and how to identify whether or not your baby is presenting with symptoms.
What is Strep-B?
Streptococcal infections are caused by bacteria called streptococci. Minuscule disease-causing bacteria are found everywhere, including the human body, its host. Dark, warm and moist ‘hotspots’ provide the perfect environment for bacteria to thrive and multiply.
There are five groups of streptococcal infections: Groups A, B, C and G and D, each one causing different types of disease with different symptoms. Group B streptococci (GBS) are particularly dangerous for the newborn baby. Pregnant women carrying this bacterium are usually unaware that they are a carrier because there are no symptoms and they don’t feel ill.
How does one get infected?
The source of GBS in pregnant women is thought to be from the rectum because it’s close to the vagina. Here the bacteria quickly breed and multiply. 10-30% of pregnant women may be carrying GBS. The bacteria is passed on to the baby during a vaginal birth, and even though the risk of the baby developing the disease is low (only 1-2%), for babies who do pick up the infection, 90% occurs within the first 24 hours – called ‘early-onset disease’ – and this can be fatal for the baby.
Strep-B and your newborn
“Group B streptococcus is one of the most frequent causes of sepsis, pneumonia and meningitis in the newborn,” says Dr Olga Perovic from the National Institute of Communicable Diseases in Sandringham, Johannesburg. “GBS is not a sexually transmitted disease, and because colonised women have no symptoms of the disease, a culture (swab) must be taken from the vaginal and rectal areas to identify the organism.”
“The majority of GBS infections in the newborn occur within the first week of life," explains Perovic. This is called early-onset disease, and is very dangerous. Late-onset infections begin a week after the birth, but may be seen up to three months after the birth. Late GBS usually manifests as meningitis (inflammation of the covering of the brain and spinal cord). “Late infections could be caused by a source other than the mother,” warns Perovic. “These may be caused by an infection in the hospital called nosocomial infections.”
You should be alert if your newborn seems to be unwell.
Symptoms of a strep B infection
You should take your baby to the doctor or go to the clinic without hesitation if your baby has any of the following symptoms:
- Listlessness and lethargy, in other words, the baby sleeps for too long and is too tired to feed.
- The baby has a temperature.
- The baby has any difficulty breathing.
- If the baby has a fit, is "jittery" or stiff.
- The baby has jaundice.
- The baby is vomiting and has diarrhoea.
- The fontanelle ('soft spots' on the baby's skull) are swollen and tight.
- The baby's cry is high-pitched.
Cleanliness and washing hands in the hospital and at home is a priority. Nursing and all medical staff must wash their hands after working with each and every mother and baby. You also need to remember and practise basic hygiene such as washing your hands and using soap and water after using the toilet. You can also boost your baby’s immunity by breastfeeding for as long as possible, and if using bottles, to sterilise them.
- Also read: Your baby: What's normal, what's not
Parent24 spoke to specialist gynaecologist at Christiaan Barnard Memorial Hospital, Dr Mark AV Faesen, on how women can get tested for Strep-B:
Strep-B in SA
Dr Faesen explains that routine antenatal GBS testing is not universally done nor is it specifically recommended. “The reason for that is that it is too expensive to test every pregnant woman for GBS (with 20-40% infection rate in the general population) and treat every pregnant woman for GBS infection, since the chances of serious consequences are extremely small."
He continues, “Too many pregnant women have to be tested and treated to prevent one serious neonatal infection. So routine testing and treating will lead to too many pregnant women receiving antibiotics who do not need it.”
That being said, he explains that in SA we generally follow the Royal College of Obstetricians & Gynaecologists's reccommendations for Strep-B testing and treatment, but these are simply guidelines. He says, “Many obstetricians will have their own approach, either based on a bad experience with one of their patients in the past, or out of fear of consequences and litigation, which on its own often leads to over-testing and over-treating.”
- Also read: How doctors test for Down Syndrome
How to get tested
Dr Faesen explains that women need to specifically enquire about Strep-B and request to get tested. “Testing is done usually by taking a vaginal swab from a pregnant woman and sending it off to the lab for testing for GBS. Also, a rectal swab can be used for testing but I am sure that most women prefer the vaginal swab.
“The best timing for testing is 3-5 weeks before planned delivery (at 35-37 weeks of pregnancy). If found positive for GBS, treatment is not given immediately, but only given when in labour or if membranes have ruptured, even without labour.”
If treated straight away, women risk the chance of the infection coming back after the treatment within the same pregnancy, he explains.
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