Long term outcomes after infant GBS disease in England (GBS-LTO)

Group B streptococcus (GBS) is the leading cause of severe infection such as sepsis, meningitis and pneumonia in newborn babies in the UK. GBS can be passed from mother to baby around labour, and from mothers and others after birth. Most babies colonised with GBS remain well, but 3 in every 100 colonised babies develop GBS infection, usually in the first two days after birth, and very rarely after age 3 months. Giving intravenous antibiotics to the mother during labour reduces the risk of newborn infection. However, there are concerns about giving many women antibiotics to prevent a small number of infections; that the longer-term effects of antibiotics on the mother and baby are unknown; and giving antibiotics may contribute to antibiotic resistance.

Universal GBS testing in pregnancy is offered in most developed countries but not in the UK because of uncertainty in the evidence about whether it both works and offers the NHS value for money. Consequently, the National Institute for Health Research (NIHR) has funded a large study (GBS3), led by the University of Nottingham, to measure the benefits and costs of routinely testing women for GBS colonisation in late pregnancy or during labour, compared with the current UK risk-based approach. This study will provide the UK National Screening Committee with evidence to decide whether women should be offered testing for GBS in pregnancy or around birth.

To ensure GBS3’s findings reflect both the immediate and longer-term consequences for babies who develop GBS infection, mathematical modelling will be used to estimate the outcomes over these babies’ lifetimes. Every child’s healthcare record contains information about their health across their life, but these are not necessarily linked well enough to find associations between GBS infection and development or later illness.

Some relevant information from the Netherlands and Demark was published recently but these findings may not be identical for UK children or reflect the experience of NHS patients due to differences in how health services are organised in the UK, Denmark and the Netherlands.

Our aim in this study is to link routinely collected UK data to understand better the long-term outlook for babies who develop GBS infection. To do this, we will measure and compare survival, health-related quality of life and healthcare needs, of individuals who had and who did not have GBS infection as a baby. We will use three datasets to answer the research questions: the Clinical Practice Research Datalink (CPRD), which collects information from GP practices; Hospital Episode Statistics (HES), which contains data from hospitals; and the Office for National Statistics which collates data on all deaths in the UK.

Amount awarded: £45,441