What are the signs and symptoms of neonatal GBS infection that I should be vigilant for in newborns?

Signs and symptoms of neonatal Group B Streptococcus (GBS) infection to be vigilant for include both red flag and other clinical indicators. Red flag signs are apnoea (temporary cessation of breathing), seizures, need for cardiopulmonary resuscitation, need for mechanical ventilation, and signs of shock. Other important clinical indicators include altered behaviour or responsiveness, altered muscle tone such as floppiness, feeding difficulties including feed refusal, feed intolerance (vomiting, excessive gastric aspirates, abdominal distension), abnormal heart rate (bradycardia or tachycardia), respiratory distress signs (grunting, recession, tachypnoea), hypoxia (central cyanosis or reduced oxygen saturation), persistent pulmonary hypertension of the newborn, jaundice within 24 hours of birth, signs of neonatal encephalopathy, temperature abnormalities (below 36°C or above 38°C unexplained by environment), unexplained excessive bleeding or abnormal coagulation, altered glucose homeostasis (hypoglycaemia or hyperglycaemia), and metabolic acidosis (base deficit ≥10 mmol/l) NICE NG195.

These clinical features reflect early-onset neonatal infection, which typically presents within the first 72 hours of life and can rapidly progress. Vigilance for these signs is critical, especially in newborns with known risk factors such as maternal GBS colonisation, prolonged rupture of membranes, intrapartum fever, or previous sibling with invasive GBS infection NICE NG195.

Recent literature supports this clinical framework, emphasizing the importance of early recognition of respiratory distress, neurological signs (seizures, altered tone), and systemic signs such as shock and temperature instability as key indicators of invasive GBS disease in neonates Verani et al. 2010Stocker et al. 2024Manuel et al. 2025. These sources also highlight that early identification and prompt antibiotic treatment are essential to improve outcomes.