New WHO Guidelines Aim to Curb Deadly Neonatal Infections: A Dual Approach to Protecting Newborns

The WHO has released new guidelines on screening pregnant women for GBS to prevent severe neonatal infections. The guidelines recommend two screening strategies—universal and risk-based. While each strategy has its merits, implementation challenges in low-resource settings remain significant. The WHO calls for further research to evaluate the effectiveness of these approaches globally.

The World Health Organization (WHO) has released new recommendations aimed at preventing early-onset Group B streptococcus (GBS) disease in newborns. GBS is a common bacterial infection that affects over 390,000 newborns every year, causing severe sepsis, which can be life-threatening if not detected early. The guideline, titled "WHO Recommendation on Screening of Pregnant Women for Intrapartum Antibiotic Prophylaxis for the Prevention of Early Onset Group B Streptococcus Disease in Newborns," introduces a dual strategy for screening pregnant women to identify those who need preventive antibiotic treatment during labor.

A Two-Pronged Strategy to Fight GBS

The WHO outlines two primary strategies for preventing GBS infection in newborns—Universal Screening and Risk Factor-Based Screening. Both methods involve assessing pregnant women for GBS, which often colonizes the vagina and rectum without causing symptoms. The aim is to identify women at risk and provide intrapartum antibiotic prophylaxis (IAP) to reduce the likelihood of GBS transmission to newborns during childbirth.

Universal Screening: This strategy involves routine testing of all pregnant women between 35 and 37 weeks of gestation using a simple culture-based method, typically through rectovaginal swabbing. Women who test positive for GBS colonization are provided with IAP during labor to prevent the bacteria from passing to their newborns.

Risk Factor-Based Screening: Instead of screening all pregnant women, this approach targets women who present certain risk factors such as maternal fever, prolonged rupture of membranes, or a previous child affected by GBS disease. In these cases, IAP is administered to those identified as high-risk, thereby reducing the chances of early-onset GBS disease in the newborn.

According to the WHO Guideline Development Group (GDG), either strategy can be effective, depending on the country’s healthcare resources and maternal health infrastructure. While universal screening may seem more straightforward, the WHO acknowledges the implementation challenges, particularly in low-resource settings where access to laboratory facilities and trained healthcare workers is limited.

Implementation Hurdles: Low-Resource Settings at a Disadvantage

The effectiveness of these screening strategies varies significantly across different regions, especially when comparing high-income and low-income countries. Universal screening is more comprehensive but requires consistent access to laboratory facilities and skilled health personnel to carry out testing and administer antibiotics during labor. For many low-resource settings, this level of healthcare infrastructure is simply not feasible, making it difficult to implement universal screening on a large scale.

The risk factor-based approach, while less resource-intensive, relies heavily on the accurate identification of risk factors and on well-trained healthcare staff who can recognize and respond to these factors quickly. However, the WHO report highlights that even this method faces challenges due to variations in how risk factors are defined and the inconsistency of protocols across different regions.

Another critical issue raised in the report is the lack of local data on the prevalence of GBS in low-income and middle-income countries. Without this data, it is difficult to assess the true burden of GBS and to tailor screening strategies that effectively address the needs of these regions.

The Need for More Research and Global Action

While the recommendations are a step in the right direction, the WHO underscores that more research is needed to address several gaps. One of the main research priorities is to evaluate the cost-effectiveness and feasibility of both screening strategies in resource-poor settings. This includes understanding the financial burden of implementing universal screening compared to a risk-based approach and the potential long-term impact on public health.

Another area of concern is the long-term effects of intrapartum antibiotic prophylaxis on newborns. Some studies suggest that early exposure to antibiotics could disrupt the gut microbiome and increase the risk of conditions such as asthma and obesity later in life. As a result, the WHO calls for more longitudinal studies to assess the impact of IAP on child development and health outcomes.

Furthermore, the report suggests that as new technologies, such as rapid intrapartum testing, become more widely available, they could revolutionize screening by providing faster and more accurate results. Such advancements would be especially beneficial in low-resource settings, where the current challenges of cost, infrastructure, and workforce capacity limit the implementation of universal screening.

A Global Call for Action

The WHO’s new guidelines on GBS screening emphasize the need for countries to evaluate their healthcare systems and adopt strategies that are both effective and sustainable. The WHO urges policymakers and health leaders to prioritize maternal and neonatal health by investing in infrastructure, training healthcare workers, and gathering local data to better understand the prevalence of GBS.

For high-income countries with robust healthcare systems, universal screening could be a lifesaving standard practice. However, in low-resource settings, a risk-based approach may be more practical in the short term, provided it is backed by adequate training and resources. As research continues to shed light on the best practices for GBS prevention, the WHO remains committed to supporting countries in their efforts to protect the most vulnerable—newborns.