新生儿早发型B族链球菌败血症27例临床分析

Early onset of group B streptococcal sepsis in newborn: clinical analysis of 27 cases

目的 分析早发型B族链球菌(group B streptococcal,GBS)败血症的临床特点,提高对早发型GBS败血症的认识。 方法 回顾陆军总医院附属八一儿童医院2013年1月至2017年11月双份血培养阳性的新生儿早发型GBS败血症患儿临床资料,分析临床表现、实验室检查、并发症、预后及围产期特点等。 结果 共纳入新生儿早发型GBS败血症27例,占同期住院患儿的0.85‰(27/31 936)。其中早产儿6例,足月儿21例。发病时间均在生后24 h内,除1例足月儿以发热为首发症状外,其余病例均以呼吸困难为首发症状,伴有反应差、肌张力低下等。17例患儿需呼吸机辅助呼吸,其中1例足月儿因呼吸困难不能缓解、肺动脉高压、持续低氧血症等,于生后48 h内行体外膜肺氧合治疗;另10例患儿需头罩吸氧。并发化脓性脑膜炎5例(18.5%,5/27)。血常规白细胞(0.8-34.2)×10^9/L,血小板最低16×10^9/L,C反应蛋白最高249 mg/L,降钙素原最高>100 ng/ml。所有患儿血培养药敏均显示对青霉素敏感,应用青霉素并根据病情加用美罗培南或更换为万古霉素治疗。2例因病情危重抢救无效死亡;5例因病情危重、家长担心后遗症放弃治疗出院后短时间内死亡,总病死率25.9%(7/27)。余20例患儿临床治愈出院。 结论 新生儿早发型GBS败血症病情危重,发病时间早,进展快,病死率较高,应加强围产期GBS感染管理,早期识别、综合治疗,降低发病率和病死率。

Objective To study the clinical features of early-onset Group B streptococcal(GBS) sepsis to improve the management of early-onset GBS sepsis. Method To review the clinical data of 27 cases of early-onset GBS sepsis in the Hospital over the past 5 years (January 2013 to November 2017), and analyze its clinical features, laboratory results, complications, prognosis and perinatal characteristics. Result A total of 27 cases of early-onset GBS sepsis were enrolled within 5 years, accounting for 0.85‰(27/31 936) of total hospitalized patients over the same period. Among them, 6 were premature infants and 21 full-term infants. The time of onset was within 24 hours. In all the cases, except for one full-term infant with fever as the initial symptom, the remainder had dyspnea as the initial symptom, accompanied by poor response and low poor muscle tone. Among them, 17 patients required assisted ventilation. One of the full-term infant treated with ECMO within 48 hours after birth because of dyspnea, pulmonary hypertension and persistent hypoxemia, etc., and improved and discharged;another 10 patients needed hood oxygen supply. 5 cases (18.5%, 5/27) diagnosed with purulent meningitis. In complete blood count, white blood cells ranged from (0.8-34.2)×10^9/L, the minimum platelets counts was 16×10^9/L, the maximum CRP was 249 mg/L, and maximum procalcitonin was>100 ng/ml. All blood cultures were sensitive to penicillin. of the 27 patients, 2 died despite of medical treatment, and 5 patients died as their parents worried about possible sequelae and discharged against medical advice. Therefore, the total mortality rate was 25.9% (7/27). All children were administered penicillin after the blood culture results were known, meropenem was subsequently added or replaced with vancomycin according to the clinical progress of the child. The remaining 20 patients recovered and discharged. Conclusion The clinical manifestation of early onset GBS septicemia is critically ill, with early onset, rapid progress, and high mortality. Special attention should be paid to high-risk cases during perinatal period, and early recognition with effective treatment would reduce morbidity and mortality.