孕晚期GBS筛查阳性对婴儿临床结局的影响

Effect of GBS positive screening in late pregnancy on infant clinical outcomes

目的探究孕晚期B族链球菌(group B Streptococcus,GBS)定植对婴儿临床结局的影响。方法采用病例队列研究法,随机选取2018年10月至2020年9月在孕晚期产检GBS筛查阳性的孕妇及其所分娩婴儿395例作为观察对象,同时选取同一时期产检GBS筛查阴性的孕妇及其所分娩婴儿800例作为对照组进行对比分析,比较两组新生儿的感染发生情况,分析GBS定植孕妇所生婴儿的临床结局。观察组中,双阳性组121例,阴拭子阳性组136例,肛拭子阳性组138例,比较三组的孕妇所分娩婴儿的临床结局,探讨GBS筛查双阳性及单阳性对婴儿结局的影响。结果观察组与对照组婴儿临床结局的比较中,胎儿窘迫、窒息、黄疸、早产等的发生率差异无统计学意义(P>0.05),而观察组新生儿感染的发生率高于对照组,差异有统计学意义(P<0.01)。观察组中,比较阴肛拭子双阳性组、阴拭子阳性组和肛拭子阳性组的新生儿临床结局,三组胎儿窘迫、新生儿窒息、黄疸、新生儿感染等差异均无统计学意义(P>0.05)。GBS筛查阳性孕妇中,132例实施产时抗生素预防(IAP组),263例未实施产时抗生素预防(无IAP组),两组孕妇所分娩婴儿的临床结局比较,早产发生率差异无统计学意义(P>0.05),黄疸、窒息、新生儿感染的发生率IAP组较低,差异有统计学意义(P<0.05或0.01)。结论孕晚期GBS筛查阳性对新生儿早期感染有很大影响,应实施抗生素预防,其所分娩婴儿均属高危儿,需密切监测,必要时干预治疗,以改善临床结局。

Objective To explore the effect of group B Streptococcus(GBS)colonization in late pregnancy on the clinical outcomes of infants.Methods Case cohort study method was used,and 395 pregnant women with positive prenatal GBS screening in late pregnancy from October 2018 to September 2020 and their babies were randomly selected as observation objects.800 pregnant women with negative prenatal GBS screening and their infants in the same period were selected as control group for comparative analysis.And then,the incidence of neonatal infection was compared between the two groups,and the clinical outcomes of infants born to pregnant women with GBS colonization were analyzed.In the observation group,there were 121 cases in double positive group,136 cases in vaginal swab positive group and 138 cases in anal swab positive group.The clinical outcomes of infants born to pregnant women in the three groups were compared,and the effects of double positive and single positive GBS screening on clinical outcomes of infants were discussed.Results In the comparison of clinical outcomes of infants of the observation group and the control group,there was no statistically significant difference in the incidence of fetal distress,asphyxia,jaundice and premature delivery between the two groups(P>0.05),while the incidence of neonatal infection in the observation group was higher than that in the control group,and difference was statistically significant(P<0.01).In the observation group,the neonatal outcomes of the double positive group,the vaginal swab positive group and the anal swab positive group were compared,and there were no statistically significant differences in fetal distress,neonatal asphyxia,jaundice and neonatal infection among the three groups(P>0.05).Among the pregnant women with positive GBS screening,132 cases were given intrapartum antibiotic prophylaxis(IAP group),and 263 cases were not given intrapartum antibiotic prophylaxis(no IAP group),there was no statistically significant difference in the incidence of premature birth between the two groups(P>0.05),but the incidence of jaundice,asphyxia and neonatal infection was lower in the IAP group,and difference was statistically significant(P<0.05 or 0.01).Conclusion Positive GBS screening have a great impact on neonatal early-onset infection,antibiotic prevention should be implemented.The infants delivered are high-risk,who need close monitoring and intervention if necessary to improve the clinical outcomes.