Benitz W E, Gould J B, Druzin M L
Department of Pediatrics, Stanford University School of Medicine, Stanford, California 94305, USA.
Pediatrics. 1999 Jun;103(6):e78. doi: 10.1542/peds.103.6.e78.
To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.
Literature review and reanalysis of published data.
The rate of early-onset GBS sepsis in high-risk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.
Women with chorioamnionitis or premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.
确定可降低新生儿早发型B族链球菌（GBS）败血症发病率的干预措施。
文献综述及对已发表数据的重新分析。
通过使用抗生素可降低高危新生儿早发型GBS败血症的发病率。孕期治疗（产前预防）无法降低分娩时产妇GBS定植率。静脉注射氨苄西林可使胎膜早破早产产妇所生婴儿的早发型感染风险降低56%，GBS感染风险降低36%；加用庆大霉素可能会提高氨苄西林的疗效。产时使用氨苄西林和庆大霉素治疗绒毛膜羊膜炎产妇可使新生儿败血症的发生率降低82%，GBS感染的发生率降低86%。新生儿出生后不久普遍使用青霉素（产后预防）可使早发型GBS发病率降低68%，但总体死亡率会增加40%，因此不建议使用。产时预防，单独使用或与婴儿产后预防联合使用，可分别使早发型GBS发病率降低80%或95%。
患有绒毛膜羊膜炎或胎膜早破的产妇及其婴儿应接受静脉注射氨苄西林和庆大霉素治疗。产时抗菌预防可能适用于其他婴儿感染风险增加但风险程度较低的产妇，部分婴儿可能需要补充产后预防。选择合适的候选对象和预防策略需要仔细考虑每位患者的成本和收益。B族链球菌、新生儿败血症、早发型败血症、预防、预防措施
