Health
Many parents are unaware of a rare form of meningitis that puts newborns at risk.
A rare form of meningitis that puts newborns at risk.
Baby Koen Hughes is lucky to be alive. If his parents, Sarah and Steve, hadn’t been concerned about his high-pitched cries and rushed him to the local health centre, if the doctor there hadn’t sent them on to the Kidz First Children’s Hospital despite the three-week-old not having a high temperature at that point and if hospital staff hadn’t acted so fast to resuscitate Koen, whose breathing by then had turned to grunting, he would have died.
“We didn’t realise it but his system was shutting down,” says Sarah. “We were told that if we’d waited a couple of hours, the outcome would have been very different.”
That high-pitched crying and grunting are classic symptoms of deadly group B streptococcus (GBS) meningitis. It’s a condition the Hugheses had never heard about, and now they are asking why.
GBS is a common bacterium that lives in our bodies without our knowing. About a quarter of women carry it in their vaginas and it doesn’t cause a problem unless they are giving birth, when they can pass it to their babies.
In some places – including North America – there is a routine swab test at 35-37 weeks, and mothers who test positive for GBS receive intravenous antibiotics during labour, which significantly reduces the chance of the baby developing a blood infection, pneumonia or meningitis.
In New Zealand, three babies in 10,000 are thought to be infected per year, and rather than universal screening, we have a risk-based prevention strategy. So, for instance, if a mother has had a previous GBSinfected baby, if her waters break but she doesn’t go into labour for 18 hours or more, or if she has a fever during the delivery, then she will be treated with antibiotics.
Auckland District Health Board (DHB) obstetrician Michelle Wise was among the authors of our national guidelines for the prevention of earlyonset GBS in newborns, and explains some of the factors it was necessary to consider. For a start, GBS bacteria come and go. “Just because you test negative for it at 35 weeks doesn’t mean you couldn’t be positive at 41 weeks,” says Wise.
That was balanced with the issue of large numbers of mothers being given antibiotics unnecessarily at a time when we are concerned about antibiotic resistance. Often women are reluctant to have the medication, and those hoping for a home birth or natural labour don’t want the process medicalised.
“Early-onset GBS is rare,” says Wise. “The problem is that when it occurs, it’s terrible. It happens within a few days of the birth and the baby gets overwhelmingly sick really fast.”
Wise trained and worked in Canada,
where a swab test for GBS is routine. “With either strategy, you’re going to end up missing some cases,” she says. “It’s not a preventable disease; it’s more risk reduction. However, women in Canada do tend to be much more informed. Here, if you don’t develop a risk factor, you’re probably not going to hear about it, and most midwives will never have come across a baby with it.”
After six weeks of antibiotics, two MRIs, one CT scan, two EEGs, four lumbar punctures and countless blood tests, baby Koen was discharged from hospital and is now home with his parents in Waiuku, south Auckland. He suffered swelling around his brain, and only time will tell what sort of long-term damage there has been. This means his parents are looking extra carefully for signs of normal developmental milestones.
“At the moment, he is doing everything he should be doing for a three-month-old baby,” says Sarah. “His eyes are tracking and he’s smiling. Every day he’s looking better.”
The couple don’t know if screening Sarah during pregnancy would have made a difference, as Koen’s condition was late onset, meaning the bacteria could have been picked up elsewhere. But they are concerned that so few New Zealand parents seem aware of GBS – Sarah asked around and found only one member of her antenatal group had been told about it.
She would like to see all mothers offered the option of a swab test. “But the main thing is to make people aware of it so they know the risks and can look out for symptoms. At the moment, it’s not talked about. It feels like it’s a dirty secret.”
Sarah has written to the Ministry of Health about raising awareness of GBS among parents, and last week received word from the Minister of Health, Dr Jonathan Coleman, that current GBS guidelines will be highlighted in DHB “education sessions with all maternity clinicians and lead maternity carers”.
“Just because you test negative for it at 35 weeks doesn’t mean you couldn’t be positive at 41 weeks.”