CONSIDERING STREP DURING DELIVERY NOW BETH IS DOING A SURVEY TOO, IRON

[reactive]

Seriously, yesterday evening I threw the idea out to my pediatrician the idea that since I had strep B during delivery of my son, could that have effected him. Then this moring I opened my email and there's an email from Beth Maloney regarding a survey regarding the same issue. PROFOUND! My son seems to keep getting strep no matter what antibiotics we use. His cultures are often negative so he's difficult to diagnose. I sincerely think he has strep in his gut.

Any thoughts?

I just want to add again, that rectal and vaginal group B strep can be transient; that is why it is checked at approx. 36 weeks. Which means, if you are positive at 36 weeks you probably will have it, but if negative at 36 weeks you could be positive later and it is not caught. They want check for it late enough to catch a positive, but no too late that you will deliver before the test result is in...that is why they pick 36 weeks. Even though I personally doubt a connection, even if there is it would be hard to know in every case due to the transient nature. If you are negative at 36 weeks and don't deliver until 40 or 41 weeks, you would not know with 100% certainty you did not have it. I myself, personally was negative with ds9 who may have PANDAS but positive in ds5 with no symptoms of PANDAS.

IV antibiotics are not given for the newborn benefit in +GBS women for scheduled c-sections...if you get antibiotic in the IV during your c-section it is for your benefit not the baby.

[ajcire]

I was specifically told the antibiotics were because I was strep b positive and that even though it was a section they had to regardless. The other reason I had antibiotics was because of a mitro valve prolapse... they told me that the antibiotic for the strep b was not the same as the one I needed for the mitro valve.

 

 

IV antibiotics are not given for the newborn benefit in +GBS women for scheduled c-sections...if you get antibiotic in the IV during your c-section it is for your benefit not the baby.

[ShaesMom]

I was negative for Group B during my 1st pregnancy but my son developed Group B strep at two weeks of age that progressed into Meningitis. Of course, the doctors tried to tell me it was from the delivery. I believe evidence now shows that a child older than 1 week can actually get GBS from someone other than the Mother. He does not have Pandas.

 

During two subsequent pregnancies I was tested and retested-always negative for GBS. I was also given abx at the time of delivery. My daughter with Pandas was my third pregnancy.

[bubbasmom]

I don't think my questioning this has anything to do with being a PANDAS believer or not. As with every other aspect of PANDAS it is an interesting point. My son doesn't get strep symptoms, does that mean he doesn't get strep - NO he has had many many positive cultures without so much as a sore throat or fever.

However, with the strep B - which I am aware is not 'strep throat' and I know how pregnant women have it once not the next time, but I am exploring the unusual aspect of strep in the gut. My son has a rather difficult to diagnose case of strep, and of PANDAS.

So just because its not 'typical' or didn't happen with one person does not mean it cannot happen to the next. Like most parents I will stop at nothing and leave no stone unturned until my 13 son is recovered.

 

 

Seriously, yesterday evening I threw the idea out to my pediatrician the idea that since I had strep B during delivery of my son, could that have effected him. Then this moring I opened my email and there's an email from Beth Maloney regarding a survey regarding the same issue. PROFOUND! My son seems to keep getting strep no matter what antibiotics we use. His cultures are often negative so he's difficult to diagnose. I sincerely think he has strep in his gut.

Any thoughts?

I feel like I should reply to this. I have worked in OBGYN for the last 19 years, the first 7 as a labor and delivery nurse and the rest as a OBGYN nurse practitioner. Group B strep can be found in the vagina or rectum of women, pregnant or not. It can come and go; you can be positive for one pregnancy and not in another. It is standard practice to test for group B strep about a month before delivery. If the woman is negative, no further action is needed. If the woman is positive, it is recommended the woman get antibiotics by a standard protocol before delivery; if the woman labors too quickly and all the antibiotics are not in, most hospitals then treat the newborn.

 

Group B strep can cause sepsis in a newborn; babies can get septic and die very, very quickly. The chance of sepsis and newborn death is low, even with positive strep test, but the antibiotic use in all positive women at delivery has slashed the numbers of newborn morbidity and mortality. It is a risk benefit thing. This form of strep is not the same strep that causes strep tonsillitis or step throat. Even though I am a PANDAS believer, and think my ds9 may have PANDAS or some form of PANDAS, I do not see the connection to rectal/vaginal group B strep.

[bubbasmom]

Elizabeth, that's an interesting point. I have not had titers done on everyone. I have one daughter that I keep getting cultures done on. My oldest passes out with needles so to get her tested would be a nightmare, but I guess not as big of a nightmare as PANDAS, huh!

bubbasmom:

 

Have you done the ASO and ANTI DNASE B titers on the whole family?

 

Our son had a regression post IVIG and his sister and father both had elevated strep levels in their blood work.

 

I also had strep B during delivery.

 

elizabeth

[bubbasmom]

Okay forgive my 'ignorance' on this. How do you know what strain of strep they had? Because I find that interesting because we went through that in 2007. We live in St. Louis and we knew of so many people that had strep that year and could not get rid of it for weeks and weeks. So did you just do a 'complete throat culture' to analyze what strain. I'd LOVE to know what strain my son has now because he's getting it over and over again.

 

I can only add my experience: negative for strep at time of delivery, 2 c-sections, 2 robustly healthy babies, robustly healthy kids, both have a particular strain of strep last year, both pandas now.

[bubbasmom]

I think this is exactly the information I need but I'm quite stressed right now and not really comprehending this. If you don't mind I will probably print this for the pediatrician to look at. He'll get that more I think. Thanks for everything.

 

Also, Group B can manifest Group A.

 

The type of hemolytic reaction displayed on blood agar has long been used to classify the streptococci. Beta -hemolysis is associated with complete lysis of red cells surrounding the colony, whereas alpha-hemolysis is a partial or "green" hemolysis associated with reduction of red cell hemoglobin. Nonhemolytic colonies have been termed gamma-hemolytic. Hemolysis is affected by the species and age of red cells, as well as by other properties of the base medium. Group A streptococci are nearly always beta-hemolytic; related Group B can manifest alpha, beta or gamma hemolysis. Most strains of S. pneumoniae are alpha-hemolytic but can cause ß-hemolysis during anaerobic incubation. Most of the oral streptococci and enterococci are non hemolytic. The property of hemolysis is not very reliable for the absolute identification of streptococci, but it is widely used in rapid screens for identification of S. pyogenes and S. pneumoniae.

 

http://www.tjclarkinc.com/bacterial_diseas...us_pyogenes.htm

[reactive]

I was specifically told the antibiotics were because I was strep b positive and that even though it was a section they had to regardless. The other reason I had antibiotics was because of a mitro valve prolapse... they told me that the antibiotic for the strep b was not the same as the one I needed for the mitro valve.

 

 

IV antibiotics are not given for the newborn benefit in +GBS women for scheduled c-sections...if you get antibiotic in the IV during your c-section it is for your benefit not the baby.

[/quot

OBGYN's go by the guidelines from ACOG (American College of Obstetricians and Gynecologists). They have a website...check it out. Scheduled c-sections do not require antibiotic for GBS, but if you are in labor and then get a c-section that is a different story. However, some physicians and midwives may order antibiotics anyway; that happens. The protocol for GBS prophylaxis is actually a little more complex than just a dose...where I work you need 2 doses 4 hours apart and needs to be completed before delivery...so many hospitals treat baby if all antibiotics are not in.

[reactive]

I was negative for Group B during my 1st pregnancy but my son developed Group B strep at two weeks of age that progressed into Meningitis. Of course, the doctors tried to tell me it was from the delivery. I believe evidence now shows that a child older than 1 week can actually get GBS from someone other than the Mother. He does not have Pandas.

 

During two subsequent pregnancies I was tested and retested-always negative for GBS. I was also given abx at the time of delivery. My daughter with Pandas was my third pregnancy.

Research has shown for a very long time, since the late 1980's and early 1990's that newborns can get meningitis and or sepsis from GBS at delivery in the first month of life. So, your story is not unusual. See my other post about the transient nature of GBS. You probably had it, but were negative when your test was done. See ACOG for info on GBS in pregnancy.

[ajcire]

I only know what my dr. told me.... my first is what you said... was a section, but I had been in labor first, it was not a scheduled section... My subsequent pregnancies ended up sections as well.. I was told that since I had been positive with my first for strep b that regardless of my having sections and regardless of the fact that I tested negative for strep b with my second pregnancy that they still had to treat me with the antibiotics.... Maybe my obgyn group had a problem once where they didnt' treat and maybe they just are overly cautious... I don't know.

 

I was specifically told the antibiotics were because I was strep b positive and that even though it was a section they had to regardless. The other reason I had antibiotics was because of a mitro valve prolapse... they told me that the antibiotic for the strep b was not the same as the one I needed for the mitro valve.

 

 

IV antibiotics are not given for the newborn benefit in +GBS women for scheduled c-sections...if you get antibiotic in the IV during your c-section it is for your benefit not the baby.

[/quot

OBGYN's go by the guidelines from ACOG (American College of Obstetricians and Gynecologists). They have a website...check it out. Scheduled c-sections do not require antibiotic for GBS, but if you are in labor and then get a c-section that is a different story. However, some physicians and midwives may order antibiotics anyway; that happens. The protocol for GBS prophylaxis is actually a little more complex than just a dose...where I work you need 2 doses 4 hours apart and needs to be completed before delivery...so many hospitals treat baby if all antibiotics are not in.

[Suzan]

My first dd was born at 33 weeks, emergency c-section so I was not tested for strepB. My subsequent dd was born at 36 weeks, an unscheduled early c-section. I don't think they had tested me yet for strepB since she came early so it is unknown whether I had it or not.

 

I did have my doc test me last July during my physical and it was positive for strep B so now I will always wonder.

 

Susan

[reactive]

My first dd was born at 33 weeks, emergency c-section so I was not tested for strepB. My subsequent dd was born at 36 weeks, an unscheduled early c-section. I don't think they had tested me yet for strepB since she came early so it is unknown whether I had it or not.

 

I did have my doc test me last July during my physical and it was positive for strep B so now I will always wonder.

 

Susan

It is standard of care to treat women in premature labor for group B strep. So a lot of early babies get treated. But if a c-section is for another reason, emergent,ect. they don't always have time to give antibiotics. Then the pediatrician or neonatologist decides if baby gets tested and treated. It depends on the circumstance. I think it is nice that your doctor tested you at your physical when you asked, but knowing you were positive did not help you, did it? When tested, as many as one in four women will be positive for group B strep. It can also show up in a urine culture. That is why, in my earlier post, I mentioned that it would be hard to make a connection to PANDAS. By default, as many as one in four PANDAS kids would have a positive mom when they were delivered. And that is if they were tested, as you mentioned. And also, you cannot account for the negative tests that may have actually been positive moms, as in the earlier post in this thread about the mom who had a baby develop meningitis after her negative test.

 

My goal in even posting on this thread is helping everyone see that every branch of medicine has its own research and protocols; in this case obstetrics (which I happen to know more about than PANDAS). I want every parent of a kid who may have PANDAS to know what they are talking about if they bring this group B strep issue up at any doctor's visit. With the different strains of strep, and differences in virulence, some patients with recurrent strep would need to be under the care of someone in infectious disease in difficult cases; it seems to me. And, if you think the doctors you have talked with so far don't know much about PANDAS, I will tell you most providers in OBGYN have probably not heard of it.

[Suzan]

It is standard of care to treat women in premature labor for group B strep. So a lot of early babies get treated. But if a c-section is for another reason, emergent,ect. they don't always have time to give antibiotics. Then the pediatrician or neonatologist decides if baby gets tested and treated. It depends on the circumstance. I think it is nice that your doctor tested you at your physical when you asked, but knowing you were positive did not help you, did it? When tested, as many as one in four women will be positive for group B strep. It can also show up in a urine culture. That is why, in my earlier post, I mentioned that it would be hard to make a connection to PANDAS. By default, as many as one in four PANDAS kids would have a positive mom when they were delivered. And that is if they were tested, as you mentioned. And also, you cannot account for the negative tests that may have actually been positive moms, as in the earlier post in this thread about the mom who had a baby develop meningitis after her negative test.

 

My goal in even posting on this thread is helping everyone see that every branch of medicine has its own research and protocols; in this case obstetrics (which I happen to know more about than PANDAS). I want every parent of a kid who may have PANDAS to know what they are talking about if they bring this group B strep issue up at any doctor's visit. With the different strains of strep, and differences in virulence, some patients with recurrent strep would need to be under the care of someone in infectious disease in difficult cases; it seems to me. And, if you think the doctors you have talked with so far don't know much about PANDAS, I will tell you most providers in OBGYN have probably not heard of it.

 

Thanks! My doc swabbed me for strep B at my request because of the kids last year. Otherwise he would not have done it. He did give me a round of zith but was not interested in retesting after to see if it cleared so you are right, it didn't help too much.

 

My dd8 was "emergency" but there was time to try to stop the labor so maybe they have me antibiotics then. I wonder if I can get the medical records? I was pretty out of it so I don't remember a whole lot. With dd7, my water broke at 36 weeks and she was delivered that night. I guess it doesn't matter too much now though especially since I'm pretty sure I know the instance where they got pandas when they were toddlers.

 

It is helpful to get all types of info and input on this. I did not notice after I was treated whether it helped the kids to not be exposed. They get strep in the vagina but it's strep A.

 

Susan