早发型新生儿B族链球菌败血症的围生期临床特征

Perinatal clinical features of early-onset neonatal septicemia caused by group B streptococcus

目的探讨早发型新生儿B族链球菌(GBS)败血症的围生期临床特征,提高对本病的认识和治疗水平。方法收集2005—2009年我院分娩的新生儿资料,回顾性分析GBS败血症患儿的围生期因素、发病时间、临床表现、实验室检查、治疗和预后。结果 GBS败血症7例,均为早发型感染,检出率为0.113‰。早产儿1例,生后即反应低下、呻吟、呼吸困难;实验室检查:WBC2.6×109/L,N0.76,CRP55mg/L,需呼吸机治疗。足月儿6例,于生后48h内发病,临床表现有呼吸困难、精神反应差、青紫、发热、肌张力异常等,其中1例合并化脓性脑膜炎者出现惊厥;实验室检查:WBC1.9～24.9×109/L,N0.38～0.88,CRP17～>160mg/L,1例需经鼻持续气道正压通气辅助呼吸。7例均合并肺炎,青霉素联合头孢吡肟或美罗培南治疗有效。结论我国存在新生儿GBS败血症散发病例,病情严重。应重视围生期高危因素和早期临床表现。尽早行病原学检测,选择敏感抗生素治疗可有效降低病死率。

Objective To investigate the perinatal clinical features of early-onset neonatal Group B Streptococcal septicemia in order to guide the clinical diagnosis and treatment. Methods Retrospectively analyse the perinatal factors, disease onset, clinical presentation, laboratory examination, treatment and prognosis of the 7 cases of all newborns from 2005 to 2009 in our hospital. Results The incidence of neonatal early-onset Group B Streptococcal septicemia was 0. 113%r in this study. One premature infant showed reduced activity, groaning and dyspnea at birth. Abnormal results of laboratory tests included WBC 2. 6 ×10^9/L, N 0. 76, CRP 55 mg/L. This case required assisted mechanical ventilation. The initial clinical signs of septicemia in 6 full-term infants such as reduced activity, groaning, dyspnea, cyanosis, fever and abnormal muscle tone appeared within 48 hours after birth. In addition, One case combined with purulent meningitis showed convulsion. Abnormal results of laboratory tests included WBC 1.9 -24. 9 × 10^9/L, N 0. 38 -0. 88, CRP 17 - 〉 160 mg/L One case required nCPAP. All the 7 cases combined with pneumonia. Accurate diagnosis of GBS was established by positive bacterial blood cultures. Intravenous treatment of neonatal GBS with penicillin combined with maxipine or meropenem was effective. Conclusion There are sporadic cases with GBS infection among neoanates in this country. The illness is severe. Early detection of pathogens, early treatment with sensitive antibiotic was essential and effective.