Abrams E J, Bateman D A
Department of Pediatrics, Harlem Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY 10037, USA.
Bull N Y Acad Med. 1995 Winter;72(2):443-53.
Harlem Hospital in New York City has one of the highest HIV-1 newborn seroprevalence rates in the United States. We report the results of a program introduced in 1993 and designed to identify HIV-1-seropositive (HIV+) newborns at birth. All new mothers, independent of risk, received HIV counseling that emphasized the medical imperative to know the infant's HIV status as well as their own. Consent was obtained to test the infant; discarded cord blood samples were tested by enzyme-linked immunosorbent assay (ELISA), and when positive, Western Blot confirmation. We compared the number of HIV+ infants identified through voluntary testing with the number reported by the anonymous New York State Newborn HIV Seroprevalence Study. In 1993, 97.8% (91 of 93) of the number of HIV+ infants identified by the anonymous testing were identified through voluntary maternal and newborn testing programs. Eighty-five HIV+ infants were identified before nursery discharge: 50% (42/85) through newborn testing; 14% (12/85) through prenatal testing; 13% (11/85) presented to care knowing their status; 23% (20/85) were known because of a previous HIV+ child. Six additional HIV+ children were diagnosed after hospital discharge (mean age, 5.5 months; range 1.5 through 17 months); four presented with symptomatic disease. The optimal time for identification of the HIV+ pregnant woman is before or during pregnancy, but when this does not occur, voluntary newborn testing can identify many HIV+ infants who would otherwise be discharged undiagnosed from the nursery.
纽约市的哈莱姆医院是美国HIV-1新生儿血清阳性率最高的医院之一。我们报告了1993年推出的一项计划的结果，该计划旨在在出生时识别HIV-1血清阳性（HIV+）新生儿。所有新妈妈，无论风险如何，都接受了HIV咨询，强调了解婴儿和自身HIV状况的医学必要性。获得了对婴儿进行检测的同意；废弃的脐带血样本通过酶联免疫吸附测定（ELISA）进行检测，检测呈阳性时进行蛋白免疫印迹法确认。我们将通过自愿检测识别出的HIV+婴儿数量与纽约州匿名新生儿HIV血清阳性率研究报告的数量进行了比较。1993年，通过匿名检测识别出的HIV+婴儿数量中，97.8%（93例中的91例）是通过自愿的母婴检测计划识别出来的。85名HIV+婴儿在出院前被识别出来：50%（42/85）通过新生儿检测；14%（12/85）通过产前检测；13%（11/85）在接受护理时已知其状况；23%（20/85）是因为之前有HIV+儿童而被知晓。另外6名HIV+儿童在出院后被诊断出来（平均年龄5.5个月；范围1.5至17个月）；4名出现了症状性疾病。识别HIV+孕妇的最佳时间是在怀孕前或怀孕期间，但如果没有做到这一点，自愿的新生儿检测可以识别出许多否则将未被诊断就从托儿所出院的HIV+婴儿。
