Group B streptococcus (GBS) is the most common cause of bacterial meningitis and sepsis in newborns in the United States. It is also one of the most preventable. National guidelines on screening pregnant women and administering antibiotics during labor have been in place since the 1990s, and U.S. rates of early-onset GBS disease have fallen substantially. But the residual cases — when screening was missed, prophylaxis was not given, or postpartum signs of infection were not recognized — remain serious birth injury claims.
What Group B Strep Is
GBS is a bacteria that colonizes the gastrointestinal and genital tracts of approximately 20-30% of healthy women. Most colonized women have no symptoms. The bacteria becomes dangerous when it is transmitted from mother to baby during labor and delivery, particularly to newborns whose immune systems cannot yet fight off bacterial infection.
Early-onset GBS disease (within the first week of life) typically presents within 24-48 hours of delivery as one of:
- Sepsis — bloodstream infection with systemic illness.
- Pneumonia — lung infection.
- Meningitis — infection of the brain and spinal cord linings.
Without prompt recognition and IV antibiotic treatment, early-onset GBS disease is rapidly progressive and carries a substantial mortality risk. Survivors of GBS meningitis often have long-term neurological disabilities including cerebral palsy, intellectual disability, hearing loss, and seizure disorders.
The National Screening Standard
The Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) all recommend the same screening protocol:
- Universal screening at 36-37 weeks of pregnancy. Every pregnant woman is offered a vaginal-rectal swab to test for GBS colonization.
- Intrapartum antibiotic prophylaxis (usually IV penicillin or ampicillin) for women who screen positive, plus women whose status is unknown but who have risk factors (preterm labor, prolonged rupture of membranes, intrapartum fever, or a previous GBS-affected infant).
- The first antibiotic dose at least 4 hours before delivery when possible, to achieve adequate fetal levels.
- Newborn observation for at least 24-48 hours, with closer monitoring of infants whose mothers did not receive adequate prophylaxis.
When this protocol is followed, early-onset GBS disease is prevented in the vast majority of cases. The protocol is not optional — it is the standard of care.
How Cases Get Built
GBS malpractice cases typically fall into one of these patterns:
Missed or unread screening
The mother was due for screening at 36-37 weeks. Either the test was never offered, the swab was never collected, the lab result never came back to the chart, or a positive result was overlooked. The records make this clear: no GBS swab in the prenatal record, or a positive result that was never communicated to the labor and delivery team.
Prophylaxis not given despite positive screen
The mother was GBS positive but did not receive intrapartum antibiotics. Common reasons in the chart: the screen result was in the prenatal record but not transmitted to the labor and delivery unit; the team forgot to start the antibiotic; or labor was so rapid that antibiotics were not started in time but the team did not recognize the gap.
Inadequate prophylaxis
The antibiotic was started but the first dose was not given at least 4 hours before delivery, and the newborn was not appropriately observed afterward. The standard calls for closer monitoring of these babies precisely because the antibiotic coverage was suboptimal.
Failure to recognize newborn infection
The baby developed signs of early-onset GBS disease in the first 24-48 hours — temperature instability, poor feeding, lethargy, respiratory distress, abnormal heart rate — and the team did not recognize or act on them. Delayed recognition of newborn sepsis can transform a treatable infection into a fatal or permanently disabling one.
Risk-factor cases without screening
The mother had risk factors (preterm labor, prolonged rupture of membranes, intrapartum fever) but was not given empiric prophylaxis as the guidelines require for unknown GBS status. These cases are particularly clear cut.
Why GBS cases are usually winnable. The CDC/ACOG/AAP guidelines have been in place for decades, and every U.S. labor and delivery unit knows them. When the protocol was not followed and a baby was harmed, the deviation from the standard of care is usually clear on the records.
What the Records Show
GBS malpractice cases turn on a specific set of records:
- The prenatal record — was the GBS swab ordered, collected, and resulted? Was the result communicated to labor and delivery?
- The labor and delivery record — was antibiotic prophylaxis ordered and given? When was the first dose? How many doses before delivery?
- The newborn record — what were the early vital signs, exam findings, lab values? When did concerning findings appear, and how long until they were acted on?
- Blood cultures and CSF cultures from the baby, confirming the GBS diagnosis.
- Imaging studies (head ultrasound, MRI) and follow-up neurology evaluations documenting the long-term impact.
What Long-Term Outcomes Look Like
Survivors of newborn GBS meningitis often have significant long-term disabilities. The damages calculations in these cases are similar to other severe brain injury cases — lifetime care needs, special education, vocational limitations, future medical expenses. Life care plans are central to the case. Our companion guide on what a life care plan is covers that piece.
If Your Child Had Newborn GBS Disease
If your baby was diagnosed with early-onset GBS sepsis or meningitis, the case turns on whether the screening, prophylaxis, and observation protocols were followed. The records typically answer that question, and a free case review can identify whether the case fits the pattern of a viable claim.
- Read about hospital nursing negligence: Hospital nursing negligence.
- Read about wrongful death in newborns: Infant wrongful death.
- Understand the deadlines: Birth injury statute of limitations.
- Understand life care plans: What is a life care plan?
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Sources
- Centers for Disease Control and Prevention — "Group B Strep" prevention guidelines. cdc.gov/groupbstrep
- American College of Obstetricians and Gynecologists (ACOG) — "Prevention of Group B Streptococcal Early-Onset Disease in Newborns" Committee Opinion. acog.org
- American Academy of Pediatrics — "Management of Infants at Risk for Group B Streptococcal Disease" clinical report. aap.org
- National Institutes of Health / National Library of Medicine — Newborn GBS disease research and outcomes. ncbi.nlm.nih.gov
- Society for Maternal-Fetal Medicine — Intrapartum infection management. smfm.org